Association between perceived oral health and oral health–related quality of life among hospital staff

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Methods Cross-sectional study in a Level II-1 hospital (n = 72). Oral-health–related quality of life (OHRQoL) was measured with OHIP-14 and perceived oral health (POH) with a modified HU-DBI. Bivariate associations were estimated with Spearman’s ρ and 95% confidence intervals; domain-level relationships were examined with proportional-odds ordinal logistic regression (Nagelkerke’s pseudo-R2). Results OHRQoL was distributed as 38.9% Excellent, 26.4% Fair and 34.7% Poor; POH concentrated in the Low level (52.8%), followed by Excellent (29.2%) and Fair (18.1%). POH correlated positively with OHRQoL (ρ = 0.391; 95% CI 0.18–0.57; p = 0.001). Domain-level analyses showed the strongest links for psychological discomfort (ρ = 0.421; p < 0.001; pseudo-R2 = 0.111; p = 0.027) and physical disability (ρ = 0.319; p = 0.006; pseudo-R2 = 0.167; p = 0.004); social disability (ρ = 0.242; p = 0.040; pseudo-R2 = 0.124; p = 0.017) and handicap (ρ = 0.298; p = 0.011; pseudo-R2 = 0.131; p = 0.013) were smaller but significant, whereas functional limitation was non-significant (ρ = 0.096; p = 0.424; pseudo-R2 = 0.014; p = 0.6). Conclusions Better perceived oral health is significantly associated with higher oral-health-related quality of life among hospital staff. Consequently, targeted workplace strategies, including education for self-care, pain management, and functional support, could enhance oral well-being. Moreover, open instruments and pilot reliability outputs are available to ensure transparency and reproducibility. 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F1000Research 2026, 14 :238 ( https://doi.org/10.12688/f1000research.161146.6 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] Previously titled: Impact of oral health perception on the quality of life of hospital staff Miryam Lora Loza https://orcid.org/0000-0001-5099-1314 1 , Sheyla del Pilar Alvarado-Romero https://orcid.org/0009-0005-9996-5236 1 , Katia Ninozca Flores Ledesma https://orcid.org/0000-0002-9088-5820 1 , Nancy Cuenca Robles 1 , David Rene Rodríguez Díaz https://orcid.org/0000-0002-9203-3576 2 Miryam Lora Loza https://orcid.org/0000-0001-5099-1314 1 , Sheyla del Pilar Alvarado-Romero https://orcid.org/0009-0005-9996-5236 1 , [...] Katia Ninozca Flores Ledesma https://orcid.org/0000-0002-9088-5820 1 , Nancy Cuenca Robles 1 , David Rene Rodríguez Díaz https://orcid.org/0000-0002-9203-3576 2 PUBLISHED 28 Jan 2026 Author details Author details 1 Graduate School, César Vallejo University, Lima, 15311, Peru 2 School of Human Medicine, Private University of the North, Trujillo, Lima Norte, 13001, Peru Miryam Lora Loza Roles: Conceptualization, Formal Analysis, Investigation, Writing – Original Draft Preparation, Writing – Review & Editing Sheyla del Pilar Alvarado-Romero Roles: Conceptualization, Investigation, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Katia Ninozca Flores Ledesma Roles: Data Curation, Formal Analysis, Methodology, Validation, Writing – Review & Editing Nancy Cuenca Robles Roles: Data Curation, Investigation, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing David Rene Rodríguez Díaz Roles: Data Curation, Methodology, Resources, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Oral health is closely linked to well-being at work; however, evidence in hospital personnel remains limited. Methods Cross-sectional study in a Level II-1 hospital (n = 72). Oral-health–related quality of life (OHRQoL) was measured with OHIP-14 and perceived oral health (POH) with a modified HU-DBI. Bivariate associations were estimated with Spearman’s ρ and 95% confidence intervals; domain-level relationships were examined with proportional-odds ordinal logistic regression (Nagelkerke’s pseudo-R 2 ). Results OHRQoL was distributed as 38.9% Excellent, 26.4% Fair and 34.7% Poor; POH concentrated in the Low level (52.8%), followed by Excellent (29.2%) and Fair (18.1%). POH correlated positively with OHRQoL (ρ = 0.391; 95% CI 0.18–0.57; p = 0.001). Domain-level analyses showed the strongest links for psychological discomfort (ρ = 0.421; p < 0.001; pseudo-R 2 = 0.111; p = 0.027) and physical disability (ρ = 0.319; p = 0.006; pseudo-R 2 = 0.167; p = 0.004); social disability (ρ = 0.242; p = 0.040; pseudo-R 2 = 0.124; p = 0.017) and handicap (ρ = 0.298; p = 0.011; pseudo-R 2 = 0.131; p = 0.013) were smaller but significant, whereas functional limitation was non-significant (ρ = 0.096; p = 0.424; pseudo-R 2 = 0.014; p = 0.6). Conclusions Better perceived oral health is significantly associated with higher oral-health-related quality of life among hospital staff. Consequently, targeted workplace strategies, including education for self-care, pain management, and functional support, could enhance oral well-being. Moreover, open instruments and pilot reliability outputs are available to ensure transparency and reproducibility. READ ALL READ LESS Keywords Quality of life, Perception, Oral health, Correlation, Hospital, Functional limitation. Corresponding Author(s) Miryam Lora Loza ( [email protected] ) Sheyla del Pilar Alvarado-Romero ( [email protected] ) Close Corresponding authors: Miryam Lora Loza, Sheyla del Pilar Alvarado-Romero Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Lora Loza M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Lora Loza M, Alvarado-Romero SdP, Flores Ledesma KN et al. Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.12688/f1000research.161146.6 ) First published: 26 Feb 2025, 14 :238 ( https://doi.org/10.12688/f1000research.161146.1 ) Latest published: 28 Jan 2026, 14 :238 ( https://doi.org/10.12688/f1000research.161146.6 ) Revised Amendments from Version 5 In this new version, the authors have strengthened methodological transparency and readability. A research methodology flowchart (Figure 2) has been added to summarize the study workflow from design and setting to sampling, instruments, procedure, and statistical analyses. The Methods section has been expanded to clarify questionnaire administration, response rate, data collection period, and quality control procedures. The Discussion and Conclusions have been refined to avoid causal language, to better contextualize the magnitude of the associations, and to emphasize the study’s limitations and implications for future research. To facilitate replication and improve clarity, we have added a research methodology flowchart summarizing the study workflow. The flowchart has been included in the Methods section as Figure 1, immediately after the introductory paragraph of the Methods and before the subsections (study design and context, population and sample, instruments, procedure, and statistical analysis). This figure is provided in image format, as recommended. In this new version, the authors have strengthened methodological transparency and readability. A research methodology flowchart (Figure 2) has been added to summarize the study workflow from design and setting to sampling, instruments, procedure, and statistical analyses. The Methods section has been expanded to clarify questionnaire administration, response rate, data collection period, and quality control procedures. The Discussion and Conclusions have been refined to avoid causal language, to better contextualize the magnitude of the associations, and to emphasize the study’s limitations and implications for future research. To facilitate replication and improve clarity, we have added a research methodology flowchart summarizing the study workflow. The flowchart has been included in the Methods section as Figure 1, immediately after the introductory paragraph of the Methods and before the subsections (study design and context, population and sample, instruments, procedure, and statistical analysis). This figure is provided in image format, as recommended. See the authors' detailed response to the review by Faris Yahya I Asiri See the authors' detailed response to the review by Pankaj Dhawan See the authors' detailed response to the review by Rasha Salah See the authors' detailed response to the review by Mike T John See the authors' detailed response to the review by Haslinda Ramli See the authors' detailed response to the review by Fadil Abdillah Arifin and Nur Surya Wirawan READ REVIEWER RESPONSES Introduction Oral health is an essential component of overall well-being and is closely associated with oral health–related quality of life (OHRQoL) through the ability to perform basic functions such as communicating, eating properly, and maintaining satisfactory social relationships. 1 Oral diseases affect not only oral functions but also psychological, social, and economic outcomes, causing discomfort, pain, and loss of self-esteem, and shaping the subjective perception of oral well-being. 2 , 3 The association between oral health and OHRQoL underscores its contribution to Sustainable Development Goal 3, in which oral health is a fundamental component. Within this framework, international organizations such as the FDI World Dental Federation and the World Health Organization (WHO) consider oral health a global priority because of its clear relationship with OHRQoL. WHO conceptualizes oral health as a comprehensive state that includes physical, mental, and social well-being in relation to the functionality and condition of the oral cavity, rather than the mere absence of disease, 4 while FDI Vision 2030 advances an integrative perspective that links oral well-being with sustainable public health policies. 1 , 5 Taken together, these definitions provide the policy lens through which the global burden of oral diseases must be interpreted. Accordingly, oral diseases constitute a major global public health problem that affects approximately 3.5 billion people, with a higher burden in low- and middle-income countries where about 75% of cases are concentrated. 4 Untreated dental caries is the most prevalent condition, reflecting deep inequities in access to preventive services and basic treatments. 4 , 6 , 7 In Latin America, periodontal diseases represent a widespread burden that significantly impairs OHRQoL. In Peru, the magnitude of the problem is exacerbated by the low priority assigned to oral health within health agendas, limited public investment, and an elevated oral cancer burden, which together indicate persistent gaps in prevention and early detection. 7 In response, global initiatives—most notably FDI Vision 2030 and the Seventy-fourth World Health Assembly resolution on oral health—emphasize integrating oral health into Universal Health Coverage and aligning actions with the noncommunicable disease agenda. 5 , 8 Consistent with that agenda, the WHO Global Oral Health Status Report (2022) calls for reorienting public policies to prioritize oral-health promotion and the production of scientific knowledge through national plans aligned with WHO’s strategic vision. 4 , 7 In line with this approach, WHO and FDI advocate intersectoral collaboration within broader development agendas. 4 , 5 , 9 Within healthcare systems, perceived oral health (POH) is a measurable construct that correlates with OHRQoL 10 , 11 and can be shaped by contextual factors such as limited access to dental services and workload. 12 Because negative POH undermines self-esteem and interpersonal relationships, monitoring staff well-being through OHRQoL metrics is warranted. 9 , 13 On this basis, and given the persistent regional inequities, Peruvian and Latin American evidence highlights enduring gaps in dental access and occupational constraints among healthcare workers, which in turn makes hospital-based monitoring of OHRQoL and POH particularly relevant. To ground this need empirically, the present study examines how perceived oral health relates to oral health related quality of life, among staff in a level II-1 hospital in northern Peru, a workforce that remains underrepresented in the regional literature. Figure 1 summarizes the conceptual associations tested. Accordingly, the aim of this study was to examine the association between OHRQoL and perceived oral health among staff at a level II-1 hospital in northern Peru, considering domain-level dimensions and their associations, in order to inform strategies that promote staff oral well-being and support comprehensive, patient-centered care consistent with quality criteria. 14 , 15 Conceptual diagram showing associations from perceived oral health (ordinal levels) to OHIP-14 total score and its seven domains. Figure 1. Conceptual association model. Diagram showing the hypothesized associations between perceived oral health (POH) and oral-health–related quality of life (OHRQoL, OHIP-14) domains. Associations were assessed using Spearman’s ρ (bivariate) and proportional-odds ordinal logistic regression for domain-level analyses. Higher POH levels are expected to align with better OHRQoL (lower OHIP-14 burden). Methods To facilitate replication, the methodological workflow of the study is summarized in Figure 2 (research flowchart, image format). The figure outlines the study design and setting, population and sampling, instruments, procedures, and statistical analyses. Figure 2. Research methodology flowchart (methodological framework). Summary of the study workflow from design and setting to sampling, instruments, procedures, and statistical analyses (image format). Further methodological details are described in the subsections below. Research type and design This applied study addressed a concrete problem in a hospital setting and adopted a correlational scope to estimate the strength and direction of the association between variables. A non-experimental, cross-sectional design was used; data were collected at a single time point without manipulating variables, preserving the natural context of observation. 16 , 17 Population and sample The sampling frame comprised 80 professional and technical staff at a Level II-1 hospital in northern Peru (21 physicians, 10 obstetricians, 1 dentist, 1 pharmaceutical chemist, 17 nurses, 2 psychologists, 3 biologists, 5 microbiologists, 2 medical technologists, 13 nursing technicians, 4 pharmacy technicians, and 1 laboratory technician). Eligibility criteria included being designated or contracted under the Administrative Services Contract, having at least six months of tenure, agreeing to complete both questionnaires, and signing informed consent; conversely, workers with less than six months of tenure, those on vacation or medical leave, those in outsourced modalities, those currently in SERUMS, or those who declined participation were excluded. After applying these criteria and accounting for unavailability or non-consent during data collection, 72 individuals completed both instruments and were included in the analysis, which corresponds to a participation rate of 90%. Power and sample size. An a priori power analysis (G*Power 3.1) for a two-tailed correlation with an expected ρ = 0.30, α = 0.05, and 1−β = 0.80 indicated a minimum of 67 participants; therefore, the achieved sample (n = 72) was adequate for the planned correlational analyses. 18 – 21 Variables and instruments Two primary variables were analyzed: oral health–related quality of life (OHRQoL) and perceived oral health (POH). OHRQoL is conceptualized as the subjective appraisal of the impact that oral conditions exert on the physical, emotional, and social aspects of everyday life. For its measurement, two instruments were considered: the OHIP-14 and the GOHAI. The OHIP-14 was selected because it is a validated short form that covers seven functional and psychosocial domains and has demonstrated broad applicability in Spanish-speaking contexts. Although the GOHAI is a useful tool, its predominant emphasis on functional limitation makes it more suitable for older adult populations. Given the heterogeneous composition of hospital personnel, the OHIP-14 provided broader construct coverage and greater comparability for interpreting results. 22 – 24 Perceived oral health (POH). POH denotes the subjective evaluation of one’s oral status and its links with daily functioning. For this construct, the modified Hiroshima University–Dental Behavioral Inventory (HU-DBI) was applied, originally developed by Kawamura and subsequently used and adapted in Peru. The instrument comprises 20 dichotomous items (Yes = 1; No = 0) organized across knowledge, behavior, and attitude, and it serves as an indicator of awareness, disposition, and practice regarding one’s oral health. 25 , 26 Data collection technique A structured survey was used to collect standardized data from professional and technical staff via self-administered questionnaires, without altering the work setting or the object of study. 20 Operational details and scoring For OHRQoL, the OHIP-14—original by Slade and Spencer (1994), adapted by Espinoza (2017) and validated/published by Espinoza et al. (2022) 22 – 24 —used a 5-point Likert scale (0 = never to 4 = very frequently). For interpretability, total scores followed Espinoza’s criteria: Excellent (0–2), Fair (3–9), and Poor (≥10). For domain-level descriptions (two items per domain; range 0–8), thresholds proportional to the total-scale cutoffs were applied: Excellent (0–1), Fair (2–3), Poor (≥4). For POH, the modified HU-DBI comprises 20 dichotomous items and was summarized as: Poor (0–9), Fair (10), Excellent (11–20). 25 , 26 Validity and reliability Content validity for both instruments was established by a five-member expert panel who evaluated internal consistency, conceptual clarity, thematic relevance, and informational sufficiency; the aggregated Aiken’s V was 1.00, as documented in the methodological appendix. 27 Pilot testing showed acceptable internal consistency: Cronbach’s α = 0.847 for the OHIP-14 and α = 0.804 for the modified HU-DBI, with full scoring keys and reliability outputs available in the same appendix. 27 Instrument provenance and structure follow the original OHIP-14 development and the HU-DBI framework. 22 , 25 Transparency and materials For methodological transparency and replication, all materials (OHIP-14, modified HU-DBI, expert-review matrix, and pilot reliability outputs) are openly available on Zenodo. 27 , 28 Procedure The study commenced with a formal cover letter from the Graduate School, Universidad César Vallejo, to the administrative department of the La Libertad Level II-1 Hospital requesting authorization to administer the instruments. After approval, on-site sessions were scheduled. Investigators explained objectives, procedures, confidentiality safeguards, and anonymity, and all participants provided written informed consent. Questionnaires were self-administered in discrete areas within workspaces and required approximately eight minutes per participant, minimizing distractions and contextual bias. Data analysis Analyses drew on the prior application of the HU-DBI in Peruvian settings 26 and used the anonymized dataset and methodological appendix hosted on Zenodo. 27 , 28 Computations were performed in IBM SPSS Statistics v25 and R. 29 , 30 Descriptive statistics summarized continuous variables as mean and standard deviation or median and interquartile range, as appropriate. Distributional assumptions were examined with the Kolmogorov–Smirnov test; because several variables deviated from normality (p < 0.05) and POH is ordinal, nonparametric methods were applied. Bivariate associations between OHRQoL and POH were quantified with Spearman’s ρ and 95% confidence intervals. In addition, proportional odds ordinal logistic regression models were fitted to examine the relationship between OHIP-14 domains and POH levels. Results are reported as odds ratios with 95% confidence intervals and Nagelkerke’s pseudo-R 2 . The significance level was set at α = 0.05. These analytical choices are consistent with current recommendations for ordinal, non-normally distributed data. 31 – 33 The conceptual associations tested in this study are depicted in Figure 1 . Ethics The study protocol, entitled “Quality of life and perception of oral health of the staff of a Level II-1 hospital in La Libertad, 2024,” received a favorable opinion from the Research Ethics Committee of the Master’s Program in Health Services Management, Universidad César Vallejo (Report No. 00298-2024/CEI-PMGSS; 30 January 2025). The committee authorized implementation in accordance with institutional regulations and international ethical standards, including CIOMS (2016), 34 the Belmont Report (1979), 35 and the Declaration of Helsinki (WMA, 2013). 36 All participants provided written informed consent before data collection; confidentiality was preserved through coded identifiers and de-identification of the dataset, participation was voluntary, and individuals could withdraw at any time without penalty. The study also complied with the university’s Research Ethics Code, 37 ensuring originality, transparency, and methodological rigor throughout all phases. Results Seventy-two hospital staff completed the survey. OHRQoL (OHIP-14) was distributed as 38.9% Excellent, 26.4% Fair, and 34.7% Poor ( Table 2 ). Perceived oral health (POH) concentrated at the Low level (52.8%), followed by Excellent (29.2%) and Fair (18.1%) ( Table 3 ). Bivariate association. Perceived oral health correlated positively with OHRQoL (Spearman’s ρ = 0.391, 95% CI 0.18–0.57, p = 0.001). Given the ordinal scales and non-normality, an ordinal logistic model was additionally fitted, yielding Nagelkerke’s pseudo-R 2 = 0.198, indicating modest model fit consistent with a monotonic relationship between POH and OHRQoL (p = 0.001). Full cross-tabulation and coefficients appear in Table 1 . Table 1. Relationship between oral health–related quality of life (OHRQoL) and perceived oral health (POH) among hospital staff at a level II-1 Hospital in Northern Peru, 2024. Oral Health–related Quality of Life (OHRQoL) Oral Health Perception (POH) Total Low Fair Excellent n % n % n % n % Excellent 21 29.20 6 8.30 1 1.40 28 38.90 Fair 8 11.10 1 1.40 10 13.90 19 26.40 Poor 9 12.50 6 8.30 10 13.90 25 34.70 Total 38 52.80 13 18.10 21 29.20 72 100.00 Spearman’s ρ p Nagelkerke pseudo-R 2 p 0.391 0.001 0.198 0.001 Domain-level analyses. Associations between POH and OHIP-14 domains were examined with proportional-odds ordinal logistic regression and Spearman’s ρ ( Table 4 ). The strongest links were observed for psychological discomfort (ρ = 0.421; p < 0.001; pseudo-R 2 = 0.111; p = 0.027) and physical disability (ρ = 0.319; p = 0.006; pseudo-R 2 = 0.167; p = 0.004). Social disability (ρ = 0.242; p = 0.040; pseudo-R 2 = 0.124; p = 0.017) and handicap (ρ = 0.298; p = 0.011; pseudo-R 2 = 0.131; p = 0.013) were also significant. Functional limitation was weak and non-significant (ρ = 0.096; p = 0.424; pseudo-R 2 = 0.014; p = 0.649). Synthesis. Overall, better POH aligned with better OHRQoL (lower OHIP-14 burden), with the largest domain-level contributions in psychosocial (psychological discomfort) and functional (physical disability) impacts. See Figure 1 and Tables 1 – 4 for numeric details. Table 2 summarizes OHRQoL levels and domain profiles. Overall, OHRQoL (OHIP-14) was distributed as 38.90% Excellent, 26.40% Fair, and 34.70% Poor. By domain, the highest proportions in the Excellent level were observed for social disability (76.40%) and handicap (83.30%), whereas functional limitation concentrated 34.70% in the Poor level. This pattern indicates heterogeneous domain impacts: social participation and global functioning appear comparatively preserved, while functional limitation is the most affected dimension, consistent with the OHIP-14 framework and its cross-cultural validations. 22 – 24 Table 2. Levels of oral health–related quality of life (OHRQoL) and OHIP-14 domain classifications among hospital staff at a level II-1 Hospital in Northern Peru, 2024. OHRQoL level Dimensions of Oral Health–Related Quality of Life (OHRQoL) Functional limitation Physical pain Psychological discomfort Psychological disability Physical disability Social disability Handicap Levels n % n % n % n % n % n % n % Excellent 28 38.90 32 44.40 38 52.80 39 54.20 50 69.40 55 76.40 60 83.30 Fair 19 26.40 28 38.90 23 31.90 22 30.60 18 25.00 14 19.40 10 13.90 Poor 25 34.70 12 16.70 11 15.30 11 15.30 4 5.60 3 4.20 2 2.80 Total 72 100.00 72 100.00 72 100.00 72 100.00 72 100.00 72 100.00 72 100.00 Table 3 summarizes the distribution of perceived oral health (POH) and its dimensions. Overall POH concentrated in the Low level at 52.80%, followed by Excellent at 29.20% and Fair at 18.00%. At the dimensional level, Knowledge Perception was entirely classified as Low at 100.00%, which reveals a critical knowledge gap among staff. Attitude Perception split between Low at 44.40% and Fair at 43.10%, indicating polarization between incipient and moderate attitudes. Behavior Perception peaked at the Fair level at 62.50%, suggesting acceptable but suboptimal habitual practices. Taken together, this configuration of low knowledge, intermediate attitudes, and mostly fair behaviors points to a knowledge–attitude–behavior gap that likely reflects unstructured learning processes and operational barriers. A stepwise intervention is therefore indicated: first strengthen knowledge through targeted training, then reframe attitudes through motivational messaging and clear service standards, and finally reinforce behaviors through reminders, access facilitation, and follow-up. 25 , 26 Table 3. Levels of perceived oral health (POH) and POH dimensions among hospital staff at a Level II-1 Hospital in northern Peru, 2024. Oral Health Perception (POH) Dimensions (POH) Knowledge Perception Attitude Perception Behavior Perception Levels n % n % n % n % Low 38 52.80 72 100.00 32 44.40 15 20.80 Fair 13 18.00 0 0.00 31 43.10 45 62.50 Excellent 21 29.20 0 0.00 9 12.50 12 16.70 Total 72 100.00 72 100.00 72 100.00 72 100.00 This pattern of markedly low knowledge, intermediate attitudes, and mostly regular behaviors indicates a knowledge–attitude–behavior gap associated with unstructured learning processes and operational barriers (e.g., service access times, organizational culture). Overall, the findings highlight the need for a stepwise intervention approach: strengthening knowledge (targeted training), reframing attitudes (motivational messaging and service standards), and reinforcing behaviors (reminders, access facilities, follow-up). Table 4 Domain-level analyses. Table 4 summarizes the associations between OHIP-14 domains and perceived oral health (POH) using Spearman’s ρ and ordinal logistic regression. Psychological discomfort showed the strongest link with POH (ρ = 0.421; p < 0.001) and contributed significantly to the model (Nagelkerke’s pseudo-R 2 = 0.111; p = 0.027). Physical disability was also significant (ρ = 0.319; p = 0.006; pseudo-R 2 = 0.167; p = 0.004), as was physical pain (ρ = 0.266; p = 0.024; pseudo-R 2 = 0.093; p = 0.049). Social disability (ρ = 0.242; p = 0.040; pseudo-R 2 = 0.124; p = 0.017) and handicap (ρ = 0.298; p = 0.011; pseudo-R 2 = 0.131; p = 0.013) displayed smaller but significant associations. By contrast, functional limitation was weak and non-significant (ρ = 0.096; p = 0.424; pseudo-R 2 = 0.014; p = 0.649), indicating minimal association and poor model fit for that domain. Overall, OHRQoL and POH were positively related (ρ = 0.391; 95% CI 0.18–0.57; p = 0.001); the ordinal model yielded Nagelkerke’s pseudo-R 2 = 0.198, indicating modest model fit consistent with a monotonic POH–OHRQoL relationship. Table 4. Associations between OHIP-14 domains and perceived oral health (POH) among hospital staff at a Level II-1 Hospital in Northern Peru, 2024. Functional limitation Oral Health perception (POH) Inferential analysis Low Fair Excellent Total Spearman’s ρ p-value Nagelkerke’s pseudo R 2 p n % n % n % n % Excellent 18 25.00 7 9.70 7 9.70 32 44.40 0.096 0.424 0.014 0.649 Fair 15 20.80 3 4.20 10 13.90 28 38.90 Poor 5 6.90 3 4.20 4 5.60 12 16.70 Total 38 52.80 13 18.10 21 29.20 72 100.00 Physical Pain Oral Health perception (POH) Low Fair Excellent Total n % n % n % n % Excellent 24 33.30 7 9.70 7 9.70 38 52.80 0.266 0.024 0.093 0.049 Fair 12 16.70 2 2.80 9 12.50 23 31.90 Poor 2 2.80 4 5.60 5 6.90 11 15.30 Total 38 52.80 13 18.10 21 29.20 72 100.00 Psychological discomfort Oral Health perception (POH) Low Fair Excellent Total n % n % n % n % Excellent 26 36.10 6 8.30 7 9.70 39 54.20 0.421 < 0.001 0.111 0.027 Fair 8 11.10 5 6.90 9 12.50 22 30.60 Poor 4 5.60 2 2.80 5 6.90 11 15.30 Total 38 52.80 13 18.10 21 29.20 72 100.00 Physical Disability Oral Health perception (POH) Low Fair Excellent Total n % n % n % n % Excellent 30 41.70 8 11.10 12 16.70 50 69.40 0.319 0.006 0.167 0.004 Fair 8 11.10 5 6.90 5 6.90 18 25.00 Poor 0 0.00 0 0.00 4 5.60 4 5.60 Total 38 52.80 13 18.10 21 29.20 72 100.00 Psychological disability Oral Health perception (POH) Low Fair Excellent Total n % n % n % n % Excellent 30 41.70 8 11.10 12 16.70 50 69.40 0.232 0.050 0.167 0.004 Fair 8 11.10 5 6.90 5 6.90 18 25.00 Poor 0 0.00 0 0.00 4 5.60 4 5.60 Total 38 52.80 13 18.10 21 29.20 72 100.00 Social disability Oral Health perception (POH) Low Fair Excellent Total n % n % n % n % Excellent 31 43.10 11 15.30 13 18.10 55 76.40 0.242 0.040 0.124 0.017 Fair 7 9.70 2 2.80 5 6.90 14 19.40 Poor 0 0.00 0 0.00 3 4.20 3 4.20 Total 38 52.80 13 18.10 21 29.20 72 100.00 General disability (handicap) Oral Health perception (POH) Low Fair Excellent Total n % n % n % n % Excellent 36 50.00 9 12.50 15 20.80 60 83.30 0.298 0.011 0.131 0.013 Fair 2 2.80 4 5.60 4 5.60 10 13.90 Poor 0 0.00 0 0.00 2 2.80 2 2.80 Total 38 52.80 13 18.10 21 29.20 72 100.00 Discussion Oral health–related quality of life (OHRQoL) and perceived oral health (POH) are essential determinants of the overall well-being of healthcare workers. In this regard, the study analyzed their relationship to identify priority areas for oral-health interventions. Furthermore, the discussion interprets the main findings in light of the general objective, which was to examine the association between POH and OHRQoL, and situates them within current epidemiological and health-policy frameworks, while acknowledging the inherent limitations of a cross-sectional design. In Table 1 , the distribution of categories showed heterogeneity, as OHRQoL clustered at Excellent (38.9%) and Poor (34.7%), whereas POH predominantly fell in the Low category (52.8%); moreover, the bivariate test indicated a positive, monotonic association between POH and OHRQoL (Spearman’s ρ = 0.391; 95% CI 0.18–0.57; p = 0.001). In addition, the ordinal model supported this pattern (Nagelkerke’s pseudo-R 2 = 0.198), which reflects convergence between subjective appraisal and quality-of-life impact without establishing causation. 31 – 33 These results align with Díaz-Reissner et al., 11 who reported that sociodemographic and clinical determinants shape OHRQoL and, reciprocally, self-perceived oral health. By contrast, Espinoza et al. 24 documented a higher prevalence of excellent OHRQoL (66.8%), a difference plausibly explained by contextual factors such as infrastructure, access to dental services, and occupational-health policies. Consistent with the World Health Organization’s perspective on the interdependence of oral health, quality of life, and subjective health perceptions, the present findings underscore the value of monitoring both constructs in workforce settings to inform targeted, feasible interventions. 6 Regarding OHRQoL profiles ( Table 2 ), the distribution across Excellent (38.9%), Fair (26.4%), and Poor (34.7%) coexisted with heterogeneous domain patterns: social disability (76.4%) and handicap (83.3%) concentrated in the Excellent level, whereas functional limitation clustered in the Poor level (34.7%). This divergence between global status and domain burdens accords with the OHIP-14 framework, which anticipates that specific functional complaints (for example, chewing and speech) can persist even when social participation and overall appraisal remain favorable. 22 – 24 In working populations, social roles may be buffered by adaptive behaviors and institutional support, while basic functions remain more sensitive to subclinical oral problems; this interpretation aligns with broader evidence that oral diseases influence multiple life domains with uneven intensity. 4 , 7 The pattern therefore justifies domain-targeted measures such as functional rehabilitation and pain management, implemented alongside general health-promotion strategies. Turning to POH ( Table 3 ), Low POH predominated (52.8%), followed by Excellent (29.2%) and Fair (18.0%), together with a pronounced knowledge, attitude, and behavior gap (knowledge 100% Low; attitude split between Low and Fair; behavior mainly Fair). In hospital environments, the absence of protected training time and shift misalignments can hinder routine dental care and access to reliable information; under such conditions, knowledge acquisition tends to improve more slowly, whereas behaviors may show intermediate gains when logistical barriers are partially alleviated. Evidence from HU-DBI applications supports that structured education preferentially raises knowledge and attitudes, with behaviors consolidating when organizational access improves. 25 , 26 Consistent policy guidance emphasizes institutionalizing continuous education and integrating oral health into broader well-being and universal health-coverage agendas to correct these gaps. 2 , 4 , 6 , 9 , 27 In addition, Table 3 highlights that POH concentrated in Low (52.8%), followed by Excellent (29.2%) and Fair (18.0%); the fact that knowledge was entirely Low signals a critical deficit that is plausible in settings without permanent professional development in oral health. Organizational constraints and limited access to information can depress knowledge and delay attitudinal change, whereas behaviors may improve modestly when access barriers are addressed. 2 , 4 , 6 , 9 , 27 Notably, López García reported high POH knowledge (81.5%) in another Peruvian hospital during the COVID-19 period, which suggests setting-specific differences that merit local needs assessments. 38 Addressing the dimension-level analyses ( Table 4 ), the strongest associations with perceived oral health (POH) were observed for psychological discomfort (ρ = 0.421; p < 0.001; Nagelkerke pseudo-R 2 = 0.111; p = 0.027) and physical disability (ρ = 0.319; p = 0.006; pseudo-R 2 = 0.167; p = 0.004). Social disability (ρ = 0.242; p = 0.040; pseudo-R 2 = 0.124; p = 0.017) and handicap (ρ = 0.298; p = 0.011; pseudo-R 2 = 0.131; p = 0.013) were also significant, whereas functional limitation showed a weak, non-significant relationship (ρ = 0.096; p = 0.424; pseudo-R 2 = 0.014; p = 0.649). Taken together with the global models, these gradients indicate that psychosocial strain and activity restrictions map more closely onto self-ratings of oral health than isolated functional complaints in working adults. 31 – 33 For functional limitation, the association with POH was weak and non-significant (ρ = 0.096; p = 0.424; pseudo-R 2 = 0.014; p = 0.649). This pattern is consistent with the OHIP-14 construct, in which difficulties such as chewing or pronunciation can be offset in working adults by coping strategies and role adaptation, which reduces their weight in global self-ratings of oral health. 22 – 24 Stronger links between functional symptoms and self-perception are typically observed in populations with higher vulnerability, including older adults and those with substantial tooth loss, which helps explain discrepancies with some community-based reports. 10 , 24 For physical pain, the correlation with POH was positive, small, and statistically significant (ρ = 0.266; p < 0.05). The absence of pain plausibly reduces the salience of care needs, whereas its presence degrades self-assessment, which accords with clinical and population evidence showing that pain and periodontitis severity produce measurable decrements in oral health–related quality of life and shape subjective health appraisals. 4 , 7 , 10 For psychological discomfort, the strongest association was observed (ρ = 0.421; p < 0.001; pseudo-R 2 = 0.111; p = 0.027). This dimension aggregates worry, embarrassment, and emotional strain, which individuals tend to weight heavily when forming global judgments of oral health; the gradient is theoretically coherent with the OHIP-14 emphasis on psychosocial consequences and with population analyses that attribute a substantial share of perceived burden to psychological components rather than to isolated symptoms. 4 , 7 , 22 – 24 For physical disability, the correlation was moderate and significant (ρ = 0.319; p = 0.006; pseudo-R 2 = 0.167; p = 0.004). Restrictions in daily activity, such as eating or extended speaking, map closely onto self-ratings of health, which explains the observed contribution; clinical studies that quantify periodontitis and tooth-loss effects report declines in functioning and quality of life with clear translation to perceived status, and the pattern here mirrors that direction with moderate magnitude in an active workforce. 10 , 22 – 24 For psychological disability, a small but significant association emerged (ρ = 0.232; p < 0.05). When psychological capacity is unimpaired, vigilance about oral self-care may be lower; conversely, perceived psychological constraints can heighten awareness of need. Prior OHIP-14 work describes this dimension as a mediator that links symptoms to global valuation, and contemporary reviews identify the mental-health sphere as a key modulator of perceived health. 7 , 22 – 24 For social disability, the association was weak yet significant (ρ = 0.242; p = 0.040; pseudo-R 2 = 0.124; p = 0.017). Among employed adults, social participation is often preserved despite symptoms, which tempers its influence on global perception; however, when social restrictions accumulate, self-ratings deteriorate appreciably, a behavior reported across community and clinical series and compatible with the present estimates. 4 , 7 , 10 For handicap (general disability), a small but significant association was found (ρ = 0.298; p = 0.011; pseudo-R 2 = 0.131; p = 0.013). Because this OHIP-14 dimension summarizes global consequences, it tracks closely with how respondents synthesize their oral condition into a single judgment, which supports its usefulness as a prioritization signal in occupational settings. 22 – 24 Taken together, psychosocial and disability components explain POH more convincingly than isolated functional symptoms, which is consistent with international evidence on daily-life impact and with the construct validity of the OHIP-14. 4 , 7 , 10 , 22 – 24 Methodologically, Spearman’s correlation and proportional-odds models are appropriate for ordered, non-normal indicators and support the robustness of the reported effects. 31 – 33 Practically, these gradients argue for a dual strategy in hospital workplaces: continuous education to raise knowledge and reshape attitudes, and service-access adaptations such as shift-aligned screening, expedited referrals, pain management, and functional rehabilitation to consolidate behaviors and relieve functional complaints. Routine monitoring with validated tools, namely the OHIP-14 and the HU-DBI, can underpin iterative improvement and evaluation of policy uptake in this workforce. 22 – 26 Study limitations This single-center analysis in a Level II-1 hospital constrains external validity, therefore estimates may not generalize to institutions or regions with different organizational and population profiles. The modest sample size (n = 72) and the use of non-probabilistic convenience sampling introduce risks of selection bias and imprecision. 18 Although instruments validated for healthcare settings were employed (OHIP-14 and a modified HU-DBI), both are self-report measures and are vulnerable to information and social-desirability biases; moreover, objective clinical indicators that would allow triangulation were not collected. 20 The cross-sectional design prevents causal inference and precludes assessment of within-person change over time. 16 , 17 Future research should adopt multicenter, probabilistic sampling frames and longitudinal or repeated-measures designs, incorporating clinical examinations and administrative data to improve generalizability and enable triangulation. 17 Study implications The significant association between perceived oral health and oral health–related quality of life, together with the contributions of psychological discomfort, physical disability, and social disability, supports integrated workplace strategies that address clinical and psychosocial determinants in tandem. 9 In practice, context-sensitive programs should combine continuous education in oral self-care, periodic screening, and streamlined access to dental services aligned with shift schedules, complemented by psychosocial support. 6 , 9 Routine monitoring with validated tools can guide iterative improvement and policy uptake; specifically, the OHIP-14 for oral health–related quality of life and the HU-DBI for knowledge, attitudes, and behaviors. 22 – 26 Although these findings can inform similar settings, implementation should be tailored to local institutional conditions and paired with explicit evaluation frameworks to track impact and adjust strategies over time. 9 Conclusion This study demonstrates a statistically significant association between oral health–related quality of life (OHRQoL) and perceived oral health (POH) among healthcare personnel at a Level II-1 hospital in northern Peru. The correlation was modest but consistent (Spearman’s ρ = 0.391; p = 0.001), and the ordinal logistic model indicated explanatory contribution at the global level (Nagelkerke’s pseudo-R 2 = 0.198), supporting a monotonic relation between the constructs without implying causation. At the domain level, significant associations with POH were observed for psychological discomfort (ρ = 0.421; p < 0.001; pseudo-R 2 = 0.111), physical disability (ρ = 0.319; p = 0.006; pseudo-R 2 = 0.167), social disability (ρ = 0.242; p = 0.040; pseudo-R 2 = 0.124), and handicap (ρ = 0.298; p = 0.011; pseudo-R 2 = 0.131). Psychological disability showed a borderline bivariate correlation (ρ = 0.232; p = 0.050) but contributed in the ordinal model (pseudo-R 2 = 0.167; p = 0.004). Physical pain also displayed a smaller, yet significant, bivariate association (ρ = 0.266; p = 0.024; pseudo-R 2 = 0.093; p = 0.049). Taken together, these patterns suggest that psychosocial and disability-related burdens are more tightly aligned with global self-ratings of oral health than isolated functional complaints in this workforce. Recommendations Develop continuing education programs: Design and implement educational strategies focused on oral health for hospital staff. These programs should emphasize the importance of oral hygiene, the prevention of oral diseases, and their relationship with oral health–related quality of life (OHRQoL) and professional performance. Integration into existing occupational wellness programs is recommended to ensure sustainability and institutional support. Improve access to dental services: Establish hospital-based dental services with flexible schedules adapted to the work shifts of healthcare personnel. Facilitating timely preventive care and treatment may contribute to improving oral health perception and outcomes. Monitor oral health and quality of life in the workplace: Incorporate validated instruments such as the OHIP-14 and HU-DBI into the periodic evaluations of hospital staff. This approach would enable the systematic assessment of the impact of oral health interventions while supporting a comprehensive strategy to promote occupational well-being. Data availability Underlying data All underlying data are available on Zenodo under a Creative Commons Attribution 4.0 International (CC BY 4.0) licence. The main database is deposited at https://doi.org/10.5281/zenodo.14847738 . 28 The file contains anonymized item-level responses to the Oral Health Impact Profile (OHIP-14) and the Perceived Oral Health (modified HU-DBI) questionnaires administered to hospital staff (n = 72), as well as a brief data dictionary. Extended/methodological materials . The complementary methodological appendix—including the full instruments in Spanish (OHIP-14 and HU-DBI), the expert-judgment validation matrix, and pilot reliability outputs—is available at https://doi.org/10.5281/zenodo.15236712 . 27 Notes on reuse and ethics. Data were fully anonymized; direct identifiers were removed and indirect identifiers were minimized according to the approved protocol (see Ethics). There are no restrictions on reuse; please cite the DOIs above and this article when using these materials. References 1. FDI World Dental Federation: Vision 2030: Delivering Optimal Oral Health for All [Internet].Geneva: FDI; 2021 [cited 2025 Apr 2]. Reference Source 2. Franco-Giraldo A:La salud bucal, entre la salud sistémica y la salud pública. Univ. Salud. 2021; 23 (3): 291–300. Spanish. Publisher Full Text 3. Espinosa Patrón CE, Encarnación Contreras WB: Impact of oral health on the quality of life of 11- and 12-year-old schoolchildren from the Los Álamos commune, Arauco Province, Chile, 2019 [Master’s thesis]. Lima: Universidad Peruana Cayetano Heredia; 2020. Reference Source 4. World Health Organization: Global oral health status report: Towards universal health coverage for oral health by 2030 [Internet].Geneva: WHO; 2022 [cited 2025 Apr 2]. Reference Source 5. World Health Organization: Oral health: achieving better oral health as part of the universal health coverage and noncommunicable disease agendas towards 2030: report by the Director-General [Internet]. Geneva: WHO; 2020 Dec 23. Report No.: EB148/8. Reference Source 6. World Health Organization: Oral health [Internet].Geneva: WHO; 2022 [cited 2025 Apr 2]. Reference Source 7. Peres MA, Macpherson LMD, Weyant RJ, et al. :Oral diseases: a global public health challenge. Lancet. 2019; 394 (10194): 249–260. 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Bernabe E, Marcenes W, Hernandez CR, et al. : Global, regional, and national levels and trends in the burden of oral conditions from 1990 to 2017: a systematic analysis for the Global Burden of Disease 2017 Study.J. Dent. Res.2020 Apr; 99 (4): 362–373. Epub 2020 Mar 2. PubMed Abstract | Publisher Full Text | Free Full Text 14. Abodunrin OR, Olagunju MT, Alade OT, et al. :Relationships between oral health and the Sustainable Development Goals: a scoping review. BioMed. 2023; 3 (4): 460–470. Publisher Full Text 15. Soto Paredes JF: Level of oral health practices among health professionals in the Huaura-Oyón Network. Lima, Peru, 2021 [Internet]. Lima: Universidad Nacional José Faustino Sánchez Carrión; 2022 [cited 2024 Aug 15]. Reference Source 16. Wang X, Cheng Z: Cross-sectional studies: strengths, weaknesses, and recommendations. Chest. 2020; 158 (1S): S65–S71. Publisher Full Text 17. 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Slade GD: Derivation and validation of a short-form oral health impact profile. Community Dent. Oral. Epidemiol. 1997; 25 (4): 284–290. PubMed Abstract | Publisher Full Text 23. Montero-Martín J, Bravo-Pérez M, Albaladejo-Martínez A, et al. : Validation of the Oral Health Impact Profile (OHIP-14sp) for adults in Spain. Med. Oral Patol. Oral Cir. Bucal. 2009; 14 (1): E44–E50. PubMed Abstract 24. Oliveira BH, Nadanovsky P: Psychometric properties of the Brazilian version of the Oral Health Impact Profile-short form. Community Dent. Oral Epidemiol. 2005; 33 (4): 307–314. PubMed Abstract | Publisher Full Text 25. Kawamura M, Ikeda-Nakaoka Y, Sasahara H: An assessment of oral self-care level among Japanese dental hygiene students and general nursing students using the Hiroshima University–Dental Behavioural Inventory (HU-DBI): surveys in 1990/1999. Eur. J. Dent. Educ. 2000; 4 (2): 82–88. Publisher Full Text 26. Sato M, Camino J, Rodriguez Oyakawa H, et al. : Effect of dental education on Peruvian dental students’ oral health-related attitudes and behavior. J. Dent. Educ. 2013; 77 (9): 1179–1184. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 27. Lora Loza MG, Alvarado-Romero SP. Instrumentos y anexos (OHIP-14, HU-DBI modificado, matriz de validez, alfa piloto) [material complementario]. Zenodo; 2025 [citado 8 nov 2025]. Publisher Full Text 28. Lora Loza MG, Alvarado-Romero SP. Calidad de vida y percepción de salud bucal del personal hospitalario (base anonimizada y diccionario) [conjunto de datos]. Zenodo; 2025 [citado 8 nov 2025]. Publisher Full Text 29. IBM Corp: IBM SPSS Statistics—Binary Logistic Regression.Armonk, NY: IBM; 2017. Reference Source 30. R Core Team: R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2024. Reference Source 31. Hauke J, Kossowski T: Comparison of values of Pearson’s and Spearman’s correlation coefficients on the same sets of data. Quaest Geogr. 2011; 30 (2): 87–93. Publisher Full Text 32. McCullagh P: Regression models for ordinal data. J. R. Stat. Soc. B. 1980; 42 (2): 109–127. Publisher Full Text 33. Agresti A: Analysis of Ordinal Categorical Data. 2ª ed.Hoboken (NJ): Wiley; 2010. Publisher Full Text 34. Council for International Organizations of Medical Sciences (CIOMS): International ethical guidelines for health-related research involving humans [Internet]. Geneva: CIOMS; 2016 [cited 2025 Nov 8]. Reference Source 35. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research: The Belmont Report [Internet]. Washington (DC): US Government Printing Office; 1979 [cited 2025 Nov 8]. Reference Source 36. World Medical Association: World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. 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Reference Source Comments on this article Comments (0) Version 6 VERSION 6 PUBLISHED 26 Feb 2025 ADD YOUR COMMENT Comment Author details Author details 1 Graduate School, César Vallejo University, Lima, 15311, Peru 2 School of Human Medicine, Private University of the North, Trujillo, Lima Norte, 13001, Peru Miryam Lora Loza Roles: Conceptualization, Formal Analysis, Investigation, Writing – Original Draft Preparation, Writing – Review & Editing Sheyla del Pilar Alvarado-Romero Roles: Conceptualization, Investigation, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Katia Ninozca Flores Ledesma Roles: Data Curation, Formal Analysis, Methodology, Validation, Writing – Review & Editing Nancy Cuenca Robles Roles: Data Curation, Investigation, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing David Rene Rodríguez Díaz Roles: Data Curation, Methodology, Resources, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (6) version 6 Revised Published: 28 Jan 2026, 14:238 https://doi.org/10.12688/f1000research.161146.6 version 5 Revised Published: 10 Dec 2025, 14:238 https://doi.org/10.12688/f1000research.161146.5 version 4 Revised Published: 13 Oct 2025, 14:238 https://doi.org/10.12688/f1000research.161146.4 version 3 Revised Published: 16 Jun 2025, 14:238 https://doi.org/10.12688/f1000research.161146.3 version 2 Revised Published: 02 May 2025, 14:238 https://doi.org/10.12688/f1000research.161146.2 version 1 Published: 26 Feb 2025, 14:238 https://doi.org/10.12688/f1000research.161146.1 Copyright © 2026 Lora Loza M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Lora Loza M, Alvarado-Romero SdP, Flores Ledesma KN et al. Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.12688/f1000research.161146.6 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 6 VERSION 6 PUBLISHED 28 Jan 2026 Revised Views 0 Cite How to cite this report: Arifin FA. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.195409.r453581 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v6#referee-response-453581 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 Mar 2026 Fadil Abdillah Arifin , Universitas Muslim Indonesia, Makassar, Indonesia Approved VIEWS 0 https://doi.org/10.5256/f1000research.195409.r453581 I have checked the PPT file of the flowchart that was made according ... Continue reading READ ALL I have checked the PPT file of the flowchart that was made according to the previous instructions. The flowchart is quite good and well-structured. Thank you. Competing Interests: No competing interests were disclosed. Reviewer Expertise: OHRQoL, Medical and dental education, Endodontics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Arifin FA. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.195409.r453581 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v6#referee-response-453581 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 5 VERSION 5 PUBLISHED 10 Dec 2025 Revised Views 0 Cite How to cite this report: Arifin FA and Wirawan NS. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.191197.r440649 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v5#referee-response-440649 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 30 Dec 2025 Fadil Abdillah Arifin , Universitas Muslim Indonesia, Makassar, Indonesia Nur Surya Wirawan , Department Anaesthesiology and Intensive Therapy, Universitas Hasanuddin Fakultas Kedokteran (Ringgold ID: 355661), Makassar, South Sulawesi, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.191197.r440649 1. OK 2. OK 3. I have not yet viewed the flowchart as I previously recommended. A flowchart is essential for readers to understand the research process and facilitate the replication of analogous research methodologies. The ... Continue reading READ ALL 1. OK 2. OK 3. I have not yet viewed the flowchart as I previously recommended. A flowchart is essential for readers to understand the research process and facilitate the replication of analogous research methodologies. The author has already provided clarification; however, the flowchart I am referencing is a research flowchart in image format. 4. OK 5. OK 6. OK Competing Interests: No competing interests were disclosed. Reviewer Expertise: OHRQoL, Medical and dental education, Endodontics We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Arifin FA and Wirawan NS. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.191197.r440649 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v5#referee-response-440649 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 28 Jan 2026 [email protected] Lora Loza , Graduate School, César Vallejo University, Lima, 15311, Peru 28 Jan 2026 Author Response The requested research methodology flowchart has now been provided in image format and uploaded as a separate figure file ( Figure 2: Research methodology flowchart / methodological framework ). In addition, the ... Continue reading The requested research methodology flowchart has now been provided in image format and uploaded as a separate figure file ( Figure 2: Research methodology flowchart / methodological framework ). In addition, the Methods section explicitly cites Figure 2 to guide readers through the study workflow (study design and setting, population and sampling, instruments, procedure, and statistical analyses). The authors believe this addition improves transparency and facilitates replication of analogous research methodologies. The requested research methodology flowchart has now been provided in image format and uploaded as a separate figure file ( Figure 2: Research methodology flowchart / methodological framework ). In addition, the Methods section explicitly cites Figure 2 to guide readers through the study workflow (study design and setting, population and sampling, instruments, procedure, and statistical analyses). The authors believe this addition improves transparency and facilitates replication of analogous research methodologies. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 28 Jan 2026 [email protected] Lora Loza , Graduate School, César Vallejo University, Lima, 15311, Peru 28 Jan 2026 Author Response The requested research methodology flowchart has now been provided in image format and uploaded as a separate figure file ( Figure 2: Research methodology flowchart / methodological framework ). In addition, the ... Continue reading The requested research methodology flowchart has now been provided in image format and uploaded as a separate figure file ( Figure 2: Research methodology flowchart / methodological framework ). In addition, the Methods section explicitly cites Figure 2 to guide readers through the study workflow (study design and setting, population and sampling, instruments, procedure, and statistical analyses). The authors believe this addition improves transparency and facilitates replication of analogous research methodologies. The requested research methodology flowchart has now been provided in image format and uploaded as a separate figure file ( Figure 2: Research methodology flowchart / methodological framework ). In addition, the Methods section explicitly cites Figure 2 to guide readers through the study workflow (study design and setting, population and sampling, instruments, procedure, and statistical analyses). The authors believe this addition improves transparency and facilitates replication of analogous research methodologies. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Dhawan P. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.191197.r440648 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v5#referee-response-440648 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 Dec 2025 Pankaj Dhawan , SCHOOL OF DENTAL SCIENCES, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.191197.r440648 The study is a competently executed cross-sectional analysis that makes a valuable contribution to the regional literature on occupational oral health. The authors successfully document a significant association between a staff member's subjective assessment of their oral health (Perceived Oral ... Continue reading READ ALL The study is a competently executed cross-sectional analysis that makes a valuable contribution to the regional literature on occupational oral health. The authors successfully document a significant association between a staff member's subjective assessment of their oral health (Perceived Oral Health, POH) and their overall oral-health-related quality of life (OHRQOL). This study provides compelling evidence of the link between self-perceived oral health and well-being among hospital staff, strongly supporting the need for targeted, context-specific workplace oral health promotion strategies. While the methodological limitations prevent broad generalization and causal claims, the authors have shown an excellent ability to respond to scientific peer review, leading to a much stronger and more transparent Version 5. The core finding regarding the knowledge gap is a clear mandate for immediate public health action in this setting. https://f1000research.com/articles/14-238/v4#referee-response-428725 Competing Interests: No competing interests were disclosed. Reviewer Expertise: Education, Dentistry, Research, Oral health. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Dhawan P. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.191197.r440648 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v5#referee-response-440648 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 02 Jan 2026 [email protected] Lora Loza , Graduate School, César Vallejo University, Lima, 15311, Peru 02 Jan 2026 Author Response Thank you for reviewing Version 5 and for approving the manuscript. We appreciate your confirmation that our revisions addressed the previous comments. Competing Interests: No competing interests were disclosed. Thank you for reviewing Version 5 and for approving the manuscript. We appreciate your confirmation that our revisions addressed the previous comments. Thank you for reviewing Version 5 and for approving the manuscript. We appreciate your confirmation that our revisions addressed the previous comments. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 02 Jan 2026 [email protected] Lora Loza , Graduate School, César Vallejo University, Lima, 15311, Peru 02 Jan 2026 Author Response Thank you for reviewing Version 5 and for approving the manuscript. We appreciate your confirmation that our revisions addressed the previous comments. Competing Interests: No competing interests were disclosed. Thank you for reviewing Version 5 and for approving the manuscript. We appreciate your confirmation that our revisions addressed the previous comments. Thank you for reviewing Version 5 and for approving the manuscript. We appreciate your confirmation that our revisions addressed the previous comments. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Salah R. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.191197.r440644 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v5#referee-response-440644 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 Dec 2025 Rasha Salah , University of Baghdad, Baghdad, Iraq Approved VIEWS 0 https://doi.org/10.5256/f1000research.191197.r440644 the authors have addressed my ... Continue reading READ ALL the authors have addressed my previous comments and revised the manuscript. Competing Interests: No competing interests were disclosed. Reviewer Expertise: periodontics, implantology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Salah R. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.191197.r440644 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v5#referee-response-440644 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 02 Jan 2026 [email protected] Lora Loza , Graduate School, César Vallejo University, Lima, 15311, Peru 02 Jan 2026 Author Response Thank you for reviewing Version 5 and for confirming that the manuscript revisions adequately addressed all prior comments. We appreciate your approval. Competing Interests: . Thank you for reviewing Version 5 and for confirming that the manuscript revisions adequately addressed all prior comments. We appreciate your approval. Thank you for reviewing Version 5 and for confirming that the manuscript revisions adequately addressed all prior comments. We appreciate your approval. Competing Interests: . Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 02 Jan 2026 [email protected] Lora Loza , Graduate School, César Vallejo University, Lima, 15311, Peru 02 Jan 2026 Author Response Thank you for reviewing Version 5 and for confirming that the manuscript revisions adequately addressed all prior comments. We appreciate your approval. Competing Interests: . Thank you for reviewing Version 5 and for confirming that the manuscript revisions adequately addressed all prior comments. We appreciate your approval. Thank you for reviewing Version 5 and for confirming that the manuscript revisions adequately addressed all prior comments. We appreciate your approval. Competing Interests: . Close Report a concern COMMENT ON THIS REPORT Version 4 VERSION 4 PUBLISHED 13 Oct 2025 Revised Views 0 Cite How to cite this report: Salah R. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.188626.r428728 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v4#referee-response-428728 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 21 Nov 2025 Rasha Salah , University of Baghdad, Baghdad, Iraq Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.188626.r428728 there are missing detais in the methodology: • Who administered the questionnaires? • Were they self-administered or interviewer-administered? • What was the response rate (72 out of 80 = 90%)? • Were there systematic differences between ... Continue reading READ ALL there are missing detais in the methodology: • Who administered the questionnaires? • Were they self-administered or interviewer-administered? • What was the response rate (72 out of 80 = 90%)? • Were there systematic differences between participants and non-participants? • What time period for data collection? • Any quality control measures during data collection? statistcs Despite technically correct methods, the interpretation of results is questionable: Overstating the Strength of Association A correlation of 0.391 may be statistically significant but is of questionable clinical importance. The authors never addressed: • What magnitude of correlation would be clinically meaningful? • Does a ρ = 0.391 justify implementing oral health interventions? • What is the minimal clinically important difference for OHRQoL? • Who administered the questionnaires? • Were they self-administered or interviewer-administered? • What was the response rate (72 out of 80 = 90%)? • Were there systematic differences between participants and non-participants? • What time period for data collection? • Any quality control measures during data collection? The authors acknowledge limitations but don’t provide: • Comparison of their sample characteristics to the broader hospital staff population • Discussion of how their hospital compares to other Level II-1 hospitals in Peru • Any external validation or comparison with other studies in similar settings The authors don’t adequately compare their findings to existing research: • Is ρ = 0.391 consistent with other studies? • Is this stronger or weaker than expected? • What correlations have other researchers found between POH and OHRQoL? Without this context, readers cannot judge whether the finding is novel, confirmatory, or surprisingly weak. The conclusions significantly overreach beyond what the data support. The authors: 1. Imply causality from correlational data 2. Recommend interventions without testing them 3. Generalize from a single-site convenience sample 4. Don’t adequately acknowledge the 80% unexplained variance 5. Don’t establish clinical significance of the modest correlation Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: periodontics, implantology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Salah R. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.188626.r428728 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v4#referee-response-428728 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 02 Jan 2026 [email protected] Lora Loza , Graduate School, César Vallejo University, Lima, 15311, Peru 02 Jan 2026 Author Response Dear Dr. Salah, Thank you for your careful review and for highlighting specific areas where greater methodological transparency and interpretative balance were needed. We have revised the manuscript comprehensively to ... Continue reading Dear Dr. Salah, Thank you for your careful review and for highlighting specific areas where greater methodological transparency and interpretative balance were needed. We have revised the manuscript comprehensively to address each of your concerns. (1) Missing methodological details We expanded the Methods section to clearly specify: Administration : the questionnaires were distributed and collected by trained members of the research team, while responses were completed by participants. Mode : both instruments were self-administered . Response rate : we explicitly report 72/80 (90%) . Data collection period : we now state that data were collected between September and October 2024 . Quality control : we added the quality assurance steps implemented during fieldwork and prior to analysis (on-site completeness checks and verification of data entry). Participants vs non-participants : we clarified that demographic data from non-participants were not collected , therefore systematic comparisons could not be performed; this is now explicitly acknowledged as a limitation. (2) Strength of association and clinical relevance (ρ = 0.391) (ρ = 0.391; 95% CI 0.18–0.57) We agree that statistical significance does not equate to clinical importance. We revised the Discussion and Conclusions to frame the correlation ( ρ = 0.391 ) as modest in magnitude and to avoid overstatement. We now explicitly state that these findings are associative and do not justify intervention recommendations on their own. Regarding the minimal clinically important difference (MCID) , we clarified that MCID is typically defined for longitudinal or interventional change scores, and it is not directly applicable to a cross-sectional correlational estimate. (3) Contextualization with existing research We strengthened the Discussion by adding clearer comparisons with relevant studies assessing perceived oral health and OHRQoL, so that readers can judge whether the observed association is consistent with prior evidence and whether it is confirmatory or context-specific. (4) External validity and setting comparability In the Limitations section, we expanded our discussion of generalizability, emphasizing the single-site design, convenience sampling, and the lack of benchmarking against broader staff populations and other Level II-1 hospitals. We also outlined how future multicenter studies with probabilistic sampling and clinical examinations would address these gaps. (5) Conclusions and scope of inference We revised the conclusion to remove any causal language, avoid generalization beyond the study context, acknowledge the substantial unexplained variability, and present the findings as hypothesis-generating evidence that supports the need for longitudinal and clinically triangulated research. We sincerely appreciate your recommendations, which have improved the manuscript’s transparency and interpretative rigor. Kind regards, Miryam Griselda Lora Loza On behalf of all authors Dear Dr. Salah, Thank you for your careful review and for highlighting specific areas where greater methodological transparency and interpretative balance were needed. We have revised the manuscript comprehensively to address each of your concerns. (1) Missing methodological details We expanded the Methods section to clearly specify: Administration : the questionnaires were distributed and collected by trained members of the research team, while responses were completed by participants. Mode : both instruments were self-administered . Response rate : we explicitly report 72/80 (90%) . Data collection period : we now state that data were collected between September and October 2024 . Quality control : we added the quality assurance steps implemented during fieldwork and prior to analysis (on-site completeness checks and verification of data entry). Participants vs non-participants : we clarified that demographic data from non-participants were not collected , therefore systematic comparisons could not be performed; this is now explicitly acknowledged as a limitation. (2) Strength of association and clinical relevance (ρ = 0.391) (ρ = 0.391; 95% CI 0.18–0.57) We agree that statistical significance does not equate to clinical importance. We revised the Discussion and Conclusions to frame the correlation ( ρ = 0.391 ) as modest in magnitude and to avoid overstatement. We now explicitly state that these findings are associative and do not justify intervention recommendations on their own. Regarding the minimal clinically important difference (MCID) , we clarified that MCID is typically defined for longitudinal or interventional change scores, and it is not directly applicable to a cross-sectional correlational estimate. (3) Contextualization with existing research We strengthened the Discussion by adding clearer comparisons with relevant studies assessing perceived oral health and OHRQoL, so that readers can judge whether the observed association is consistent with prior evidence and whether it is confirmatory or context-specific. (4) External validity and setting comparability In the Limitations section, we expanded our discussion of generalizability, emphasizing the single-site design, convenience sampling, and the lack of benchmarking against broader staff populations and other Level II-1 hospitals. We also outlined how future multicenter studies with probabilistic sampling and clinical examinations would address these gaps. (5) Conclusions and scope of inference We revised the conclusion to remove any causal language, avoid generalization beyond the study context, acknowledge the substantial unexplained variability, and present the findings as hypothesis-generating evidence that supports the need for longitudinal and clinically triangulated research. We sincerely appreciate your recommendations, which have improved the manuscript’s transparency and interpretative rigor. Kind regards, Miryam Griselda Lora Loza On behalf of all authors Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 02 Jan 2026 [email protected] Lora Loza , Graduate School, César Vallejo University, Lima, 15311, Peru 02 Jan 2026 Author Response Dear Dr. Salah, Thank you for your careful review and for highlighting specific areas where greater methodological transparency and interpretative balance were needed. We have revised the manuscript comprehensively to ... Continue reading Dear Dr. Salah, Thank you for your careful review and for highlighting specific areas where greater methodological transparency and interpretative balance were needed. We have revised the manuscript comprehensively to address each of your concerns. (1) Missing methodological details We expanded the Methods section to clearly specify: Administration : the questionnaires were distributed and collected by trained members of the research team, while responses were completed by participants. Mode : both instruments were self-administered . Response rate : we explicitly report 72/80 (90%) . Data collection period : we now state that data were collected between September and October 2024 . Quality control : we added the quality assurance steps implemented during fieldwork and prior to analysis (on-site completeness checks and verification of data entry). Participants vs non-participants : we clarified that demographic data from non-participants were not collected , therefore systematic comparisons could not be performed; this is now explicitly acknowledged as a limitation. (2) Strength of association and clinical relevance (ρ = 0.391) (ρ = 0.391; 95% CI 0.18–0.57) We agree that statistical significance does not equate to clinical importance. We revised the Discussion and Conclusions to frame the correlation ( ρ = 0.391 ) as modest in magnitude and to avoid overstatement. We now explicitly state that these findings are associative and do not justify intervention recommendations on their own. Regarding the minimal clinically important difference (MCID) , we clarified that MCID is typically defined for longitudinal or interventional change scores, and it is not directly applicable to a cross-sectional correlational estimate. (3) Contextualization with existing research We strengthened the Discussion by adding clearer comparisons with relevant studies assessing perceived oral health and OHRQoL, so that readers can judge whether the observed association is consistent with prior evidence and whether it is confirmatory or context-specific. (4) External validity and setting comparability In the Limitations section, we expanded our discussion of generalizability, emphasizing the single-site design, convenience sampling, and the lack of benchmarking against broader staff populations and other Level II-1 hospitals. We also outlined how future multicenter studies with probabilistic sampling and clinical examinations would address these gaps. (5) Conclusions and scope of inference We revised the conclusion to remove any causal language, avoid generalization beyond the study context, acknowledge the substantial unexplained variability, and present the findings as hypothesis-generating evidence that supports the need for longitudinal and clinically triangulated research. We sincerely appreciate your recommendations, which have improved the manuscript’s transparency and interpretative rigor. Kind regards, Miryam Griselda Lora Loza On behalf of all authors Dear Dr. Salah, Thank you for your careful review and for highlighting specific areas where greater methodological transparency and interpretative balance were needed. We have revised the manuscript comprehensively to address each of your concerns. (1) Missing methodological details We expanded the Methods section to clearly specify: Administration : the questionnaires were distributed and collected by trained members of the research team, while responses were completed by participants. Mode : both instruments were self-administered . Response rate : we explicitly report 72/80 (90%) . Data collection period : we now state that data were collected between September and October 2024 . Quality control : we added the quality assurance steps implemented during fieldwork and prior to analysis (on-site completeness checks and verification of data entry). Participants vs non-participants : we clarified that demographic data from non-participants were not collected , therefore systematic comparisons could not be performed; this is now explicitly acknowledged as a limitation. (2) Strength of association and clinical relevance (ρ = 0.391) (ρ = 0.391; 95% CI 0.18–0.57) We agree that statistical significance does not equate to clinical importance. We revised the Discussion and Conclusions to frame the correlation ( ρ = 0.391 ) as modest in magnitude and to avoid overstatement. We now explicitly state that these findings are associative and do not justify intervention recommendations on their own. Regarding the minimal clinically important difference (MCID) , we clarified that MCID is typically defined for longitudinal or interventional change scores, and it is not directly applicable to a cross-sectional correlational estimate. (3) Contextualization with existing research We strengthened the Discussion by adding clearer comparisons with relevant studies assessing perceived oral health and OHRQoL, so that readers can judge whether the observed association is consistent with prior evidence and whether it is confirmatory or context-specific. (4) External validity and setting comparability In the Limitations section, we expanded our discussion of generalizability, emphasizing the single-site design, convenience sampling, and the lack of benchmarking against broader staff populations and other Level II-1 hospitals. We also outlined how future multicenter studies with probabilistic sampling and clinical examinations would address these gaps. (5) Conclusions and scope of inference We revised the conclusion to remove any causal language, avoid generalization beyond the study context, acknowledge the substantial unexplained variability, and present the findings as hypothesis-generating evidence that supports the need for longitudinal and clinically triangulated research. We sincerely appreciate your recommendations, which have improved the manuscript’s transparency and interpretative rigor. Kind regards, Miryam Griselda Lora Loza On behalf of all authors Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Dhawan P. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.188626.r428725 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v4#referee-response-428725 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 11 Nov 2025 Pankaj Dhawan , SCHOOL OF DENTAL SCIENCES, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.188626.r428725 1. Inability to Determine Causation is the single biggest gap. The cross-sectional design can only show that a relationship exists, not why . 2. The study's findings cannot be generalized to a wider population. This is due to two key design choices: "Non-probabilistic ... Continue reading READ ALL 1. Inability to Determine Causation is the single biggest gap. The cross-sectional design can only show that a relationship exists, not why . 2. The study's findings cannot be generalized to a wider population. This is due to two key design choices: "Non-probabilistic intentional convenience sampling" is a weak sampling method. It is not random and is prone to selection bias. The sample is small (n=72) and from a single institution . The staff at this one hospital may not be representative of all hospital staff in Peru, let alone globally. 3. The study relies 100% on self-reported questionnaires (POH and OHRQoL). There is no objective clinical data . The study cannot determine if the participants' perception of "poor" oral health matches their actual clinical status (e.g., a dental exam to count carious lesions, check for periodontal disease, etc.) 4. To address the gap in causation, a longitudinal study is needed. This would involve measuring POH at the start of the study (Time 1) and then measuring OHRQoL at a later date (Time 2). This could help establish a temporal (and potentially causal) link. 5. Objective clinical examinations by a calibrated dentist to measure actual disease status (e.g., DMFT index, periodontal charting). This would allow researchers to answer a much more interesting question: How well does perceived oral health align with actual clinical oral health? 6. To enhance generalizability, a future study must use a multi-center, randomized sampling strategy, recruiting a much larger number of participants from multiple hospitals (both public and private) across different regions. Mention and discuss in the Limitations and Future Research Section. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Education, Dentistry, Research, Oral health. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Dhawan P. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.188626.r428725 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v4#referee-response-428725 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 10 Dec 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Lima, 15311, Peru 10 Dec 2025 Author Response Dear Dr. Dhawan, thank you for underscoring design and generalizability. Version 5 now makes explicit in Limitations and Future Research : (i) the cross-sectional design cannot establish causation; (ii) single-center, convenience ... Continue reading Dear Dr. Dhawan, thank you for underscoring design and generalizability. Version 5 now makes explicit in Limitations and Future Research : (i) the cross-sectional design cannot establish causation; (ii) single-center, convenience sampling and the small n limit external validity; (iii) reliance on self-report without objective clinical exams. We also outline next steps: (iv) multicenter probabilistic sampling; (v) longitudinal follow-up to establish temporal ordering; and (vi) calibrated clinical assessments (e.g., DMFT , periodontal charting). We appreciate your guidance; these clarifications are incorporated and visible in V5 (tracked). Dear Dr. Dhawan, thank you for underscoring design and generalizability. Version 5 now makes explicit in Limitations and Future Research : (i) the cross-sectional design cannot establish causation; (ii) single-center, convenience sampling and the small n limit external validity; (iii) reliance on self-report without objective clinical exams. We also outline next steps: (iv) multicenter probabilistic sampling; (v) longitudinal follow-up to establish temporal ordering; and (vi) calibrated clinical assessments (e.g., DMFT , periodontal charting). We appreciate your guidance; these clarifications are incorporated and visible in V5 (tracked). Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 10 Dec 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Lima, 15311, Peru 10 Dec 2025 Author Response Dear Dr. Dhawan, thank you for underscoring design and generalizability. Version 5 now makes explicit in Limitations and Future Research : (i) the cross-sectional design cannot establish causation; (ii) single-center, convenience ... Continue reading Dear Dr. Dhawan, thank you for underscoring design and generalizability. Version 5 now makes explicit in Limitations and Future Research : (i) the cross-sectional design cannot establish causation; (ii) single-center, convenience sampling and the small n limit external validity; (iii) reliance on self-report without objective clinical exams. We also outline next steps: (iv) multicenter probabilistic sampling; (v) longitudinal follow-up to establish temporal ordering; and (vi) calibrated clinical assessments (e.g., DMFT , periodontal charting). We appreciate your guidance; these clarifications are incorporated and visible in V5 (tracked). Dear Dr. Dhawan, thank you for underscoring design and generalizability. Version 5 now makes explicit in Limitations and Future Research : (i) the cross-sectional design cannot establish causation; (ii) single-center, convenience sampling and the small n limit external validity; (iii) reliance on self-report without objective clinical exams. We also outline next steps: (iv) multicenter probabilistic sampling; (v) longitudinal follow-up to establish temporal ordering; and (vi) calibrated clinical assessments (e.g., DMFT , periodontal charting). We appreciate your guidance; these clarifications are incorporated and visible in V5 (tracked). Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Arifin FA. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.188626.r428727 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v4#referee-response-428727 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 07 Nov 2025 Fadil Abdillah Arifin , Universitas Muslim Indonesia, Makassar, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.188626.r428727 The research is interesting as it examines the correlation between oral health perception and the quality of life among healthcare workers. This topic remains infrequently addressed, since many individuals believe that hospital personnel are exempt from health issues, especially related ... Continue reading READ ALL The research is interesting as it examines the correlation between oral health perception and the quality of life among healthcare workers. This topic remains infrequently addressed, since many individuals believe that hospital personnel are exempt from health issues, especially related to oral health. The manuscript is sufficiently solid and clear in certain sections, facilitating study for other writers employing similar methodologies. The manuscript explicitly defines the limitations of the investigation. However, we should consider revising and adding certain sections to enhance the research manuscripts. The Abstract section should not include the research objectives found in the Introduction section. The introduction should explain the reasons for the study undertaking. Furthermore, a separate section provides clarification of the research's objective. It is hoped that it will be taken into consideration. Thank you. The Introduction section addresses the limited importance of examining OHRQoL among health personnel. Although they are the primary subjects seeking solutions in this study. The author may reference findings from several studies conducted in different regions of Peru or other nations to substantiate the significance of addressing this issue and seeking solutions. A suitable transitional sentence to link the background of the work to the study objective is absent. It is hoped that it can be comprehended and taken into account. Thank you. It is strongly advised to include a research workflow represented as a concise chart in the Methods section. Starting with the recruitment of research participants and ending in data analysis. It is crucial to offer this information to facilitate readers' comprehension of the research process, hence facilitating the application of similar methodologies. It is hoped that it will be taken into consideration. Thank you. What is the author's rationale for employing sample size estimation utilizing G Power? Although other alternative approaches exist for sample calculation. Kindly provide clarification. Thank you. What is the author's rationale for employing the OHIP-14 questionnaire to assess OHRQoL? What factors should be considered when opting not to utilize alternative questionnaires such as GOHAI? Kindly elucidate the author's viewpoint. Thank you. Could the authors explain how Espinoza categorized the three types of outcomes derived from OHIP-14? All aforementioned comments were articulated to enhance the manuscript, thereby facilitating the advancement of science, particularly in dentistry. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: OHRQoL, Medical and dental education, Endodontics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Arifin FA. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.188626.r428727 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v4#referee-response-428727 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 10 Dec 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Lima, 15311, Peru 10 Dec 2025 Author Response Dear Dr. Arifin, we appreciate your helpful suggestions. In Version 5 we: (i) trimmed the Abstract to report background/methods/results/conclusion without restating the objective; (ii) strengthened the Introduction with additional context ... Continue reading Dear Dr. Arifin, we appreciate your helpful suggestions. In Version 5 we: (i) trimmed the Abstract to report background/methods/results/conclusion without restating the objective; (ii) strengthened the Introduction with additional context and an explicit bridge to the aim; (iii) clarified the study flow in the Procedure subsection (recruitment → consent → self-administered survey → scoring → analysis); (iv) justified the a priori sample size with G*Power 3.1 for ρ = 0.30, α = 0.05, 1–β = 0.80; (v) explained the choice of OHIP-14 over GOHAI for broader construct coverage in a mixed-age workforce; and (vi) detailed Espinoza’s three-level categorization and how domain thresholds were derived. We hope these edits improve clarity and replicability. All changes are visible in Version 5 (tracked). Dear Dr. Arifin, we appreciate your helpful suggestions. In Version 5 we: (i) trimmed the Abstract to report background/methods/results/conclusion without restating the objective; (ii) strengthened the Introduction with additional context and an explicit bridge to the aim; (iii) clarified the study flow in the Procedure subsection (recruitment → consent → self-administered survey → scoring → analysis); (iv) justified the a priori sample size with G*Power 3.1 for ρ = 0.30, α = 0.05, 1–β = 0.80; (v) explained the choice of OHIP-14 over GOHAI for broader construct coverage in a mixed-age workforce; and (vi) detailed Espinoza’s three-level categorization and how domain thresholds were derived. We hope these edits improve clarity and replicability. All changes are visible in Version 5 (tracked). Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 10 Dec 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Lima, 15311, Peru 10 Dec 2025 Author Response Dear Dr. Arifin, we appreciate your helpful suggestions. In Version 5 we: (i) trimmed the Abstract to report background/methods/results/conclusion without restating the objective; (ii) strengthened the Introduction with additional context ... Continue reading Dear Dr. Arifin, we appreciate your helpful suggestions. In Version 5 we: (i) trimmed the Abstract to report background/methods/results/conclusion without restating the objective; (ii) strengthened the Introduction with additional context and an explicit bridge to the aim; (iii) clarified the study flow in the Procedure subsection (recruitment → consent → self-administered survey → scoring → analysis); (iv) justified the a priori sample size with G*Power 3.1 for ρ = 0.30, α = 0.05, 1–β = 0.80; (v) explained the choice of OHIP-14 over GOHAI for broader construct coverage in a mixed-age workforce; and (vi) detailed Espinoza’s three-level categorization and how domain thresholds were derived. We hope these edits improve clarity and replicability. All changes are visible in Version 5 (tracked). Dear Dr. Arifin, we appreciate your helpful suggestions. In Version 5 we: (i) trimmed the Abstract to report background/methods/results/conclusion without restating the objective; (ii) strengthened the Introduction with additional context and an explicit bridge to the aim; (iii) clarified the study flow in the Procedure subsection (recruitment → consent → self-administered survey → scoring → analysis); (iv) justified the a priori sample size with G*Power 3.1 for ρ = 0.30, α = 0.05, 1–β = 0.80; (v) explained the choice of OHIP-14 over GOHAI for broader construct coverage in a mixed-age workforce; and (vi) detailed Espinoza’s three-level categorization and how domain thresholds were derived. We hope these edits improve clarity and replicability. All changes are visible in Version 5 (tracked). Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 3 VERSION 3 PUBLISHED 16 Jun 2025 Revised Views 0 Cite How to cite this report: Ramli H. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.183148.r392434 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v3#referee-response-392434 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 01 Sep 2025 Haslinda Ramli , University Sains Islam Malaysia, Kuala Lumpur, Malaysia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.183148.r392434 The authors have addressed my previous comments in the revised manuscript. However, further revisions are required to enhance the quality of the paper: 1. Introduction - The definitions of the abbreviations IED, UNESCO or UNDP should be ... Continue reading READ ALL The authors have addressed my previous comments in the revised manuscript. However, further revisions are required to enhance the quality of the paper: 1. Introduction - The definitions of the abbreviations IED, UNESCO or UNDP should be spelled out in the text. - A proper citation should be included for the statement “Hence the definitive IED Vision 2030 Report and the Resolution (2021) on oral health, which emphasize that oral health should be part of Universal Health Coverage (UHC) systems and in line with the global agenda to combat non-communicable diseases (NCDs)”. 2. Methodology - Provide evidence of the ethical approval issued by the institutional ethics committee including the corresponding code or reference number. 3. Result - The two categories for OHRQoL (‘Fair’ and ‘Poor’) are labelled inconsistently in Tables 1, 2, and 4 as ‘Regular’ and ‘Bad’. Please standardize the terminology for consistency. - The columns in Table 2 appear misaligned and should be corrected. 4. Discussion - How is your study consistent with the findings of Espinoza et al. (2022), given that your study reported 38.9% excellent OHRQoL, whereas Espinoza et al. (2022) reported 66.8%? Please clarify. - Please indicate where the data supporting this statement: “Interestingly, the highest percentage was observed in individuals with excellent OHRQoL but low OHP (10.4%) ”. - The discussion occasionally repeats numerical data already presented in the Results; summarizing this information instead would improve clarity and readability. 5. Conclusion - The conclusion could better emphasize the practical significance of the findings, not just the statistical relationships. - Avoid repetition of detailed statistics. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Periodontology, Oral Health-Related Quality of Life, Oral Health Research, Oral microbiology, Natural product I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ramli H. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.183148.r392434 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v3#referee-response-392434 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 13 Oct 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 13 Oct 2025 Author Response Dear Dr. Haslinda Ramli, We sincerely thank you for your valuable and constructive comments on Version 3 of our manuscript. We have carefully revised the paper to address all the ... Continue reading Dear Dr. Haslinda Ramli, We sincerely thank you for your valuable and constructive comments on Version 3 of our manuscript. We have carefully revised the paper to address all the points you raised: Abbreviations (IED, UNESCO, UNDP) are now defined at first mention, and appropriate citations have been added to the FDI Vision 2030 Report and the World Health Assembly Resolution on Oral Health (2021) . Ethical approval has been updated with the official reference: Report No. 00298-2024/CEI-PMGSS, issued on January 30, 2025 . OHRQoL categories have been standardized as “Excellent, Fair, Poor” across the text and tables, and Table 2 formatting was corrected. The Discussion now clarifies differences with Espinoza et al. (2022), explicitly indicates that the 10.4% figure comes from Table 3, and avoids repetition of numerical data. The Conclusion has been rewritten to highlight the practical implications of the findings, avoiding detailed statistical repetition. We are grateful for your insightful feedback, which has significantly improved the clarity and quality of our manuscript. Sincerely, Miryam G. Lora Loza, on behalf of all co-authors Dear Dr. Haslinda Ramli, We sincerely thank you for your valuable and constructive comments on Version 3 of our manuscript. We have carefully revised the paper to address all the points you raised: Abbreviations (IED, UNESCO, UNDP) are now defined at first mention, and appropriate citations have been added to the FDI Vision 2030 Report and the World Health Assembly Resolution on Oral Health (2021) . Ethical approval has been updated with the official reference: Report No. 00298-2024/CEI-PMGSS, issued on January 30, 2025 . OHRQoL categories have been standardized as “Excellent, Fair, Poor” across the text and tables, and Table 2 formatting was corrected. The Discussion now clarifies differences with Espinoza et al. (2022), explicitly indicates that the 10.4% figure comes from Table 3, and avoids repetition of numerical data. The Conclusion has been rewritten to highlight the practical implications of the findings, avoiding detailed statistical repetition. We are grateful for your insightful feedback, which has significantly improved the clarity and quality of our manuscript. Sincerely, Miryam G. Lora Loza, on behalf of all co-authors Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 25 Nov 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 25 Nov 2025 Author Response Dear Dr. Ramli, as an update from V3: Version 5 standardizes OHRQoL categories as Excellent, Fair, Poor across text and tables, corrects Table 2 alignment, expands citations to FDI Vision ... Continue reading Dear Dr. Ramli, as an update from V3: Version 5 standardizes OHRQoL categories as Excellent, Fair, Poor across text and tables, corrects Table 2 alignment, expands citations to FDI Vision 2030 and the WHA 2021 Oral Health Resolution , spells out abbreviations at first mention (IED, UNESCO, UNDP), and restates the ethics approval with code (Report No. 00298-2024/CEI-PMGSS; 30 Jan 2025). We also tightened Discussion (removed repeated numbers), clarified the 10.4% statement, and emphasized practical implications in the Conclusion. All edits are visible in V5 (tracked) Dear Dr. Ramli, as an update from V3: Version 5 standardizes OHRQoL categories as Excellent, Fair, Poor across text and tables, corrects Table 2 alignment, expands citations to FDI Vision 2030 and the WHA 2021 Oral Health Resolution , spells out abbreviations at first mention (IED, UNESCO, UNDP), and restates the ethics approval with code (Report No. 00298-2024/CEI-PMGSS; 30 Jan 2025). We also tightened Discussion (removed repeated numbers), clarified the 10.4% statement, and emphasized practical implications in the Conclusion. All edits are visible in V5 (tracked) Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 13 Oct 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 13 Oct 2025 Author Response Dear Dr. Haslinda Ramli, We sincerely thank you for your valuable and constructive comments on Version 3 of our manuscript. We have carefully revised the paper to address all the ... Continue reading Dear Dr. Haslinda Ramli, We sincerely thank you for your valuable and constructive comments on Version 3 of our manuscript. We have carefully revised the paper to address all the points you raised: Abbreviations (IED, UNESCO, UNDP) are now defined at first mention, and appropriate citations have been added to the FDI Vision 2030 Report and the World Health Assembly Resolution on Oral Health (2021) . Ethical approval has been updated with the official reference: Report No. 00298-2024/CEI-PMGSS, issued on January 30, 2025 . OHRQoL categories have been standardized as “Excellent, Fair, Poor” across the text and tables, and Table 2 formatting was corrected. The Discussion now clarifies differences with Espinoza et al. (2022), explicitly indicates that the 10.4% figure comes from Table 3, and avoids repetition of numerical data. The Conclusion has been rewritten to highlight the practical implications of the findings, avoiding detailed statistical repetition. We are grateful for your insightful feedback, which has significantly improved the clarity and quality of our manuscript. Sincerely, Miryam G. Lora Loza, on behalf of all co-authors Dear Dr. Haslinda Ramli, We sincerely thank you for your valuable and constructive comments on Version 3 of our manuscript. We have carefully revised the paper to address all the points you raised: Abbreviations (IED, UNESCO, UNDP) are now defined at first mention, and appropriate citations have been added to the FDI Vision 2030 Report and the World Health Assembly Resolution on Oral Health (2021) . Ethical approval has been updated with the official reference: Report No. 00298-2024/CEI-PMGSS, issued on January 30, 2025 . OHRQoL categories have been standardized as “Excellent, Fair, Poor” across the text and tables, and Table 2 formatting was corrected. The Discussion now clarifies differences with Espinoza et al. (2022), explicitly indicates that the 10.4% figure comes from Table 3, and avoids repetition of numerical data. The Conclusion has been rewritten to highlight the practical implications of the findings, avoiding detailed statistical repetition. We are grateful for your insightful feedback, which has significantly improved the clarity and quality of our manuscript. Sincerely, Miryam G. Lora Loza, on behalf of all co-authors Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 25 Nov 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 25 Nov 2025 Author Response Dear Dr. Ramli, as an update from V3: Version 5 standardizes OHRQoL categories as Excellent, Fair, Poor across text and tables, corrects Table 2 alignment, expands citations to FDI Vision ... Continue reading Dear Dr. Ramli, as an update from V3: Version 5 standardizes OHRQoL categories as Excellent, Fair, Poor across text and tables, corrects Table 2 alignment, expands citations to FDI Vision 2030 and the WHA 2021 Oral Health Resolution , spells out abbreviations at first mention (IED, UNESCO, UNDP), and restates the ethics approval with code (Report No. 00298-2024/CEI-PMGSS; 30 Jan 2025). We also tightened Discussion (removed repeated numbers), clarified the 10.4% statement, and emphasized practical implications in the Conclusion. All edits are visible in V5 (tracked) Dear Dr. Ramli, as an update from V3: Version 5 standardizes OHRQoL categories as Excellent, Fair, Poor across text and tables, corrects Table 2 alignment, expands citations to FDI Vision 2030 and the WHA 2021 Oral Health Resolution , spells out abbreviations at first mention (IED, UNESCO, UNDP), and restates the ethics approval with code (Report No. 00298-2024/CEI-PMGSS; 30 Jan 2025). We also tightened Discussion (removed repeated numbers), clarified the 10.4% statement, and emphasized practical implications in the Conclusion. All edits are visible in V5 (tracked) Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 02 May 2025 Revised Views 0 Cite How to cite this report: Asiri FYI. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.180950.r382126 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v2#referee-response-382126 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 May 2025 Faris Yahya I Asiri , King Faisal University, Al-Ahsa, Saudi Arabia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180950.r382126 All of my previous comments appear to have been addressed in the revised manuscript. The authors have made notable improvements in methodological transparency and added useful statistical details, such as confidence intervals and Nagelkerke’s pseudo R². The inclusion of sample ... Continue reading READ ALL All of my previous comments appear to have been addressed in the revised manuscript. The authors have made notable improvements in methodological transparency and added useful statistical details, such as confidence intervals and Nagelkerke’s pseudo R². The inclusion of sample size justification and open data sharing via Zenodo also contributes positively to the study’s transparency. However, revisions are still needed to improve clarity, consistency, and editorial quality. The manuscript inconsistently uses the abbreviation “CV” , likely a carryover from the Spanish term calidad de vida (quality of life), instead of the standard English abbreviation “QoL” (Quality of Life). For example, in the Results section: “38.90% of the staff with excellent CV reported a low PSB of 52.80%, while 34.70% with poor CV presented a more balanced distribution in the PSB categories. Also, a low positive correlation (r = 0.391), but significant (p = 0.001), was evident between CV and PSB.” Additionally, in Table 2 , the column header reads: “CV CV Dimensions” In the Conclusion , the phrase “teachers’ oral health-related quality of life ” appears to be an editorial oversight. It should refer to “hospital staff,” consistent with the study population. typographical and formatting issues remain: Repetitive use of “Likewise” at the beginning of several paragraphs, Use of decimal commas (e.g., “52,8%”) instead of decimal points (e.g., “52.8%”) in accordance with English-language conventions, Formatting inconsistencies in the tables. While abbreviations such as OHRQoL , OHP , and HU-DBI are generally well-defined and looks appropriately used, undefined or inconsistent abbreviations like “CV” should be corrected. Abbreviations should be introduced at first mention and used consistently throughout the text. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Oral Health Research, Dental Public Health, Oral Epidemiology, Special Care Dentistry, Oral Health-Related Quality of Life, Health Promotion I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Asiri FYI. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.180950.r382126 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v2#referee-response-382126 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 15 Jul 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 15 Jul 2025 Author Response Dear Dr. Faris Yahya I. Asiri, We sincerely thank you for your constructive observations and recognition of the improvements made in our revised version. In response to your remaining ... Continue reading Dear Dr. Faris Yahya I. Asiri, We sincerely thank you for your constructive observations and recognition of the improvements made in our revised version. In response to your remaining concerns, we implemented the following updates: - **Terminology:** The abbreviation "CV" was replaced throughout the manuscript with the internationally accepted term "QoL". - **Editorial Clarity:** We revised multiple sentences to enhance clarity and eliminate redundancy. - **Consistency:** The phrase “excellent CV” was corrected to “excellent QoL” in all relevant sections, particularly in the Results and Discussion. - **Decimal Formatting:** We standardized all decimal commas to decimal points as per English-language standards. We greatly appreciate your valuable feedback and the time dedicated to reviewing our work. Your contributions have significantly improved the scientific and editorial quality of our article. Kind regards, Miryam Griselda Lora Loza Corresponding Author Dear Dr. Faris Yahya I. Asiri, We sincerely thank you for your constructive observations and recognition of the improvements made in our revised version. In response to your remaining concerns, we implemented the following updates: - **Terminology:** The abbreviation "CV" was replaced throughout the manuscript with the internationally accepted term "QoL". - **Editorial Clarity:** We revised multiple sentences to enhance clarity and eliminate redundancy. - **Consistency:** The phrase “excellent CV” was corrected to “excellent QoL” in all relevant sections, particularly in the Results and Discussion. - **Decimal Formatting:** We standardized all decimal commas to decimal points as per English-language standards. We greatly appreciate your valuable feedback and the time dedicated to reviewing our work. Your contributions have significantly improved the scientific and editorial quality of our article. Kind regards, Miryam Griselda Lora Loza Corresponding Author Competing Interests: None declared. Close Report a concern Author Response 25 Nov 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 25 Nov 2025 Author Response Dear Dr. Asiri, thank you for your careful review. Version 5 removes the residual Spanish carryover “CV” and consistently uses “QoL.” We corrected the stray “teachers” term to “hospital staff,” ... Continue reading Dear Dr. Asiri, thank you for your careful review. Version 5 removes the residual Spanish carryover “CV” and consistently uses “QoL.” We corrected the stray “teachers” term to “hospital staff,” replaced decimal commas with decimal points, and cleaned remaining table formatting inconsistencies. Abbreviations are now defined at first mention and used consistently. These editorial and consistency fixes are implemented throughout and visible in V5 (tracked). Dear Dr. Asiri, thank you for your careful review. Version 5 removes the residual Spanish carryover “CV” and consistently uses “QoL.” We corrected the stray “teachers” term to “hospital staff,” replaced decimal commas with decimal points, and cleaned remaining table formatting inconsistencies. Abbreviations are now defined at first mention and used consistently. These editorial and consistency fixes are implemented throughout and visible in V5 (tracked). Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 15 Jul 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 15 Jul 2025 Author Response Dear Dr. Faris Yahya I. Asiri, We sincerely thank you for your constructive observations and recognition of the improvements made in our revised version. In response to your remaining ... Continue reading Dear Dr. Faris Yahya I. Asiri, We sincerely thank you for your constructive observations and recognition of the improvements made in our revised version. In response to your remaining concerns, we implemented the following updates: - **Terminology:** The abbreviation "CV" was replaced throughout the manuscript with the internationally accepted term "QoL". - **Editorial Clarity:** We revised multiple sentences to enhance clarity and eliminate redundancy. - **Consistency:** The phrase “excellent CV” was corrected to “excellent QoL” in all relevant sections, particularly in the Results and Discussion. - **Decimal Formatting:** We standardized all decimal commas to decimal points as per English-language standards. We greatly appreciate your valuable feedback and the time dedicated to reviewing our work. Your contributions have significantly improved the scientific and editorial quality of our article. Kind regards, Miryam Griselda Lora Loza Corresponding Author Dear Dr. Faris Yahya I. Asiri, We sincerely thank you for your constructive observations and recognition of the improvements made in our revised version. In response to your remaining concerns, we implemented the following updates: - **Terminology:** The abbreviation "CV" was replaced throughout the manuscript with the internationally accepted term "QoL". - **Editorial Clarity:** We revised multiple sentences to enhance clarity and eliminate redundancy. - **Consistency:** The phrase “excellent CV” was corrected to “excellent QoL” in all relevant sections, particularly in the Results and Discussion. - **Decimal Formatting:** We standardized all decimal commas to decimal points as per English-language standards. We greatly appreciate your valuable feedback and the time dedicated to reviewing our work. Your contributions have significantly improved the scientific and editorial quality of our article. Kind regards, Miryam Griselda Lora Loza Corresponding Author Competing Interests: None declared. Close Report a concern Author Response 25 Nov 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 25 Nov 2025 Author Response Dear Dr. Asiri, thank you for your careful review. Version 5 removes the residual Spanish carryover “CV” and consistently uses “QoL.” We corrected the stray “teachers” term to “hospital staff,” ... Continue reading Dear Dr. Asiri, thank you for your careful review. Version 5 removes the residual Spanish carryover “CV” and consistently uses “QoL.” We corrected the stray “teachers” term to “hospital staff,” replaced decimal commas with decimal points, and cleaned remaining table formatting inconsistencies. Abbreviations are now defined at first mention and used consistently. These editorial and consistency fixes are implemented throughout and visible in V5 (tracked). Dear Dr. Asiri, thank you for your careful review. Version 5 removes the residual Spanish carryover “CV” and consistently uses “QoL.” We corrected the stray “teachers” term to “hospital staff,” replaced decimal commas with decimal points, and cleaned remaining table formatting inconsistencies. Abbreviations are now defined at first mention and used consistently. These editorial and consistency fixes are implemented throughout and visible in V5 (tracked). Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 26 Feb 2025 Views 0 Cite How to cite this report: Ramli H. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.177142.r371450 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v1#referee-response-371450 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 16 Apr 2025 Haslinda Ramli , University Sains Islam Malaysia, Kuala Lumpur, Malaysia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.177142.r371450 The study explores the relationship between oral health perception (OHP) and quality of life (QoL) among hospital staff. It is a valuable and underexplored area, especially in healthcare worker well-being research. However, several sections of the manuscript require clarifications and ... Continue reading READ ALL The study explores the relationship between oral health perception (OHP) and quality of life (QoL) among hospital staff. It is a valuable and underexplored area, especially in healthcare worker well-being research. However, several sections of the manuscript require clarifications and revisions: Title: The use of “impact” in the title and throughout the manuscript implies a causal relationship, which is not supported by the cross-sectional design. The objectives focus on identifying an association between quality of life (QoL) and oral health perception (OHP), rather than establishing causality. Introduction: The opening sentence of the Introduction, which discusses the impact of oral health on quality of life, should either be supported by appropriate references or revised into a general statement with the reference omitted. Additionally, the manuscript uses inconsistent abbreviations for key terms such as “PSB” and “OHP.” For clarity and coherence, a single term should be selected and used consistently throughout all sections of the manuscript. Methodology: 1) The OHIP-14 and HU-DBI questionnaires are appropriate, validated tools for measuring oral health related QoL and oral health perceptions, respectively. Their reliability (Cronbach’s alpha > 0.8) supports the soundness of the data collected. 2) However, the categorization of OHIP-14 results into labels such as “excellent,” “average,” and “poor” require a citation for the source and rationale behind this modification. 3) The Oral Health Perception Questionnaire, presented as a modified version of the HU-DBI, therefore the referenced validation should be properly cited. 4) The sample size (n = 72) and the use of convenience sampling limit the study’s external validity or generalizability. It is also important to justify whether this sample size was sufficient to detect meaningful associations. Results: The use of Spearman correlation and ordinal logistic regression is appropriate. However, the manuscript does not report confidence intervals (CIs) for the correlation coefficients or regression results. Although the correlation observed (ρ = 0.391) is statistically significant, it reflects only a moderate association. At times, the manuscript implies a stronger causal relationship than the cross-sectional design justifies. To ensure accuracy, causal language should be softened in the abstract and conclusion Discussion & conclusion: The observed association between OHP and QoL is modest, and the findings should be interpreted with caution. Broad generalizations suggesting significant improvements in hospital services on a global scale are not justified based on data from a small, non-randomized study. References: Cruzado et al. (2024) should be included Writing and Language Issues: Language editing is needed to improve clarity and flow. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Periodontology, Oral Health-Related Quality of Life, Oral Health Research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ramli H. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.177142.r371450 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v1#referee-response-371450 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 02 May 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 02 May 2025 Author Response Dear Reviewer, Thank you for your valuable feedback and for approving our manuscript with reservations. Each of your thoughtful suggestions has contributed to enhancing the quality and clarity of ... Continue reading Dear Reviewer, Thank you for your valuable feedback and for approving our manuscript with reservations. Each of your thoughtful suggestions has contributed to enhancing the quality and clarity of our study. Below we present our responses to each comment, along with the corresponding actions taken: 1. **Use of the word “Impact” in the title** ➤ *Action taken:* We revised the title to remove any causal implications. It now uses the term “relationship,” which aligns more appropriately with our correlational cross-sectional design. 2. **Abbreviations Consistency** ➤ *Action taken:* The abbreviation “OHP” (Oral Health Perception) has been standardized and used consistently throughout the entire manuscript. 3. **Justification for OHIP-14 Categories** ➤ *Action taken:* We included justification based on prior studies by Espinoza (2017) and Espinoza et al. (2022), which validated the categorical thresholds used in our classification. 4. **HU-DBI Validation** ➤ *Action taken:* We clarified that the HU-DBI instrument was adapted by Midolo (2023) and internally validated by Alvarado and Lora (2024). Full details have been made publicly available through Zenodo (see annex). 5. **Confidence Intervals and Nagelkerke’s R²** ➤ *Action taken:* We included confidence intervals and Nagelkerke’s pseudo R² values in both the results section and the associated tables. 6. **Causal Language in Abstract and Conclusion** ➤ *Action taken:* We revised all instances of causal language, replacing them with neutral expressions that more accurately indicate association or correlation. 7. **English Grammar and Flow** ➤ *Action taken:* The manuscript has undergone a full English language review to improve fluency, readability, and academic tone. 8. **Reference to Cruzado et al. (2024)** ➤ *Action taken:* This reference has been removed, as it was not cited nor included in the final reference list. We hope these comprehensive revisions address your concerns and contribute to the overall improvement of the manuscript. We are grateful for your expert guidance. Sincerely, **Miryam Griselda Lora Loza** (Corresponding Author) Dear Reviewer, Thank you for your valuable feedback and for approving our manuscript with reservations. Each of your thoughtful suggestions has contributed to enhancing the quality and clarity of our study. Below we present our responses to each comment, along with the corresponding actions taken: 1. **Use of the word “Impact” in the title** ➤ *Action taken:* We revised the title to remove any causal implications. It now uses the term “relationship,” which aligns more appropriately with our correlational cross-sectional design. 2. **Abbreviations Consistency** ➤ *Action taken:* The abbreviation “OHP” (Oral Health Perception) has been standardized and used consistently throughout the entire manuscript. 3. **Justification for OHIP-14 Categories** ➤ *Action taken:* We included justification based on prior studies by Espinoza (2017) and Espinoza et al. (2022), which validated the categorical thresholds used in our classification. 4. **HU-DBI Validation** ➤ *Action taken:* We clarified that the HU-DBI instrument was adapted by Midolo (2023) and internally validated by Alvarado and Lora (2024). Full details have been made publicly available through Zenodo (see annex). 5. **Confidence Intervals and Nagelkerke’s R²** ➤ *Action taken:* We included confidence intervals and Nagelkerke’s pseudo R² values in both the results section and the associated tables. 6. **Causal Language in Abstract and Conclusion** ➤ *Action taken:* We revised all instances of causal language, replacing them with neutral expressions that more accurately indicate association or correlation. 7. **English Grammar and Flow** ➤ *Action taken:* The manuscript has undergone a full English language review to improve fluency, readability, and academic tone. 8. **Reference to Cruzado et al. (2024)** ➤ *Action taken:* This reference has been removed, as it was not cited nor included in the final reference list. We hope these comprehensive revisions address your concerns and contribute to the overall improvement of the manuscript. We are grateful for your expert guidance. Sincerely, **Miryam Griselda Lora Loza** (Corresponding Author) Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 15 Jul 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 15 Jul 2025 Author Response Dear Reviewer, We truly appreciate your valuable and detailed feedback on our manuscript. Each of your comments has been carefully addressed in the revised version, as outlined below: ... Continue reading Dear Reviewer, We truly appreciate your valuable and detailed feedback on our manuscript. Each of your comments has been carefully addressed in the revised version, as outlined below: Use of the term “impact” in the title ➤ Action taken: The title has been modified to eliminate any causal language. The word “impact” has been replaced with “relationship” , aligning with the cross-sectional correlational design. Inconsistent use of abbreviations ("OHP" vs. "PSB") ➤ Action taken: All abbreviations have been standardized across the manuscript. We consistently use “OHP” to refer to Oral Health Perception. Lack of justification for OHIP-14 categories ➤ Action taken: We added references to Espinoza (2017) and Espinoza et al. (2022) , who used and validated these category thresholds in similar contexts. HU-DBI validation not clearly cited ➤ Action taken: We clarified that the questionnaire was adapted by Midolo (2023) and validated internally by Alvarado & Lora (2024) . Full instruments and validation details have been published in Zenodo: https://doi.org/10.5281/zenodo.15236712 Lack of Confidence Intervals (CI) and pseudo R² ➤ Action taken: Confidence intervals and Nagelkerke's pseudo R² values have been added in the results and relevant tables. Causal language in the abstract and conclusion ➤ Action taken: All expressions implying causality were removed and replaced with appropriate associative terminology. Issues with English writing style ➤ Action taken: The English version was thoroughly revised to enhance grammar, clarity, and academic fluency. Reference to Cruzado et al. (2024) ➤ Action taken: This reference was deleted, as it was not cited in the body of the text and not included in the final reference list. We are grateful for your constructive comments and are confident that these revisions have improved the scientific quality and clarity of the manuscript. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) [email protected] Dear Reviewer, We truly appreciate your valuable and detailed feedback on our manuscript. Each of your comments has been carefully addressed in the revised version, as outlined below: Use of the term “impact” in the title ➤ Action taken: The title has been modified to eliminate any causal language. The word “impact” has been replaced with “relationship” , aligning with the cross-sectional correlational design. Inconsistent use of abbreviations ("OHP" vs. "PSB") ➤ Action taken: All abbreviations have been standardized across the manuscript. We consistently use “OHP” to refer to Oral Health Perception. Lack of justification for OHIP-14 categories ➤ Action taken: We added references to Espinoza (2017) and Espinoza et al. (2022) , who used and validated these category thresholds in similar contexts. HU-DBI validation not clearly cited ➤ Action taken: We clarified that the questionnaire was adapted by Midolo (2023) and validated internally by Alvarado & Lora (2024) . Full instruments and validation details have been published in Zenodo: https://doi.org/10.5281/zenodo.15236712 Lack of Confidence Intervals (CI) and pseudo R² ➤ Action taken: Confidence intervals and Nagelkerke's pseudo R² values have been added in the results and relevant tables. Causal language in the abstract and conclusion ➤ Action taken: All expressions implying causality were removed and replaced with appropriate associative terminology. Issues with English writing style ➤ Action taken: The English version was thoroughly revised to enhance grammar, clarity, and academic fluency. Reference to Cruzado et al. (2024) ➤ Action taken: This reference was deleted, as it was not cited in the body of the text and not included in the final reference list. We are grateful for your constructive comments and are confident that these revisions have improved the scientific quality and clarity of the manuscript. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) [email protected] Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 02 May 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 02 May 2025 Author Response Dear Reviewer, Haslinda Ramli, Universiti Kebangsaan Malaysia Warm greetings. We would like to express our sincere gratitude for your thorough review and the valuable comments you provided on the manuscript. ... Continue reading Dear Reviewer, Haslinda Ramli, Universiti Kebangsaan Malaysia Warm greetings. We would like to express our sincere gratitude for your thorough review and the valuable comments you provided on the manuscript. Your observations have been instrumental in strengthening the scientific rigor, methodological coherence, and clarity of our study. Below, we outline our responses to each of the points you raised: Use of the term "impact" in the title Action taken: The original title was modified to remove any causal connotation. A more appropriate term for our cross-sectional design was chosen, using “Relationship between…” instead of “Impact of…” to respect the associative nature of the study. Inconsistent use of abbreviations ("OHP" vs. "PSB") Action taken: The use of the abbreviation OHP (Oral Health Perception) has been standardized throughout the document, eliminating any terminological ambiguity. Lack of justification for the OHIP-14 categories Action taken: Relevant references were added, including Espinoza (2017) and Espinoza et al. (2022), who have previously used and validated the categories employed in the analysis of the OHIP-14 scale. Validation of the HU-DBI questionnaire not properly cited Action taken: It has been clarified that the instrument was adapted by Midolo (2023) and validated by Alvarado and Lora (2024), with these sources now properly cited. Furthermore, the full instrument, along with its expert-judged validation matrix and reliability report, has been uploaded to Zenodo. Availability of the full instruments Action taken: Complete versions of the OHIP-14 and HU-DBI (Spanish version) are now publicly available on Zenodo, including the validation matrices, internal reliability analysis, and the anonymized database. Database and statistical results: https://doi.org/10.5281/zenodo.14847738 Methodological annex with instruments and validation: https://doi.org/10.5281/zenodo.15236712 Absence of confidence intervals and fit indicators (pseudo R²) Action taken: Confidence intervals (95% CI) and Nagelkerke's pseudo R² values have been included in the results section and respective tables. Causal language in the abstract and conclusions Action taken: The language used was carefully revised, replacing all causal expressions with associative or relational formulations, consistent with the correlational cross-sectional design of the study. Reference to Cruzado et al. (2024) Action taken: This reference has been removed, as it was not cited in the text and does not appear in the final list of references. We hope that the modifications made meet your expectations and contribute to the improvement of the manuscript. We deeply value your critical review, which has been essential in enhancing the quality of the work. Sincerely, Miryam Griselda Lora Loza Corresponding Author Dear Reviewer, Haslinda Ramli, Universiti Kebangsaan Malaysia Warm greetings. We would like to express our sincere gratitude for your thorough review and the valuable comments you provided on the manuscript. Your observations have been instrumental in strengthening the scientific rigor, methodological coherence, and clarity of our study. Below, we outline our responses to each of the points you raised: Use of the term "impact" in the title Action taken: The original title was modified to remove any causal connotation. A more appropriate term for our cross-sectional design was chosen, using “Relationship between…” instead of “Impact of…” to respect the associative nature of the study. Inconsistent use of abbreviations ("OHP" vs. "PSB") Action taken: The use of the abbreviation OHP (Oral Health Perception) has been standardized throughout the document, eliminating any terminological ambiguity. Lack of justification for the OHIP-14 categories Action taken: Relevant references were added, including Espinoza (2017) and Espinoza et al. (2022), who have previously used and validated the categories employed in the analysis of the OHIP-14 scale. Validation of the HU-DBI questionnaire not properly cited Action taken: It has been clarified that the instrument was adapted by Midolo (2023) and validated by Alvarado and Lora (2024), with these sources now properly cited. Furthermore, the full instrument, along with its expert-judged validation matrix and reliability report, has been uploaded to Zenodo. Availability of the full instruments Action taken: Complete versions of the OHIP-14 and HU-DBI (Spanish version) are now publicly available on Zenodo, including the validation matrices, internal reliability analysis, and the anonymized database. Database and statistical results: https://doi.org/10.5281/zenodo.14847738 Methodological annex with instruments and validation: https://doi.org/10.5281/zenodo.15236712 Absence of confidence intervals and fit indicators (pseudo R²) Action taken: Confidence intervals (95% CI) and Nagelkerke's pseudo R² values have been included in the results section and respective tables. Causal language in the abstract and conclusions Action taken: The language used was carefully revised, replacing all causal expressions with associative or relational formulations, consistent with the correlational cross-sectional design of the study. Reference to Cruzado et al. (2024) Action taken: This reference has been removed, as it was not cited in the text and does not appear in the final list of references. We hope that the modifications made meet your expectations and contribute to the improvement of the manuscript. We deeply value your critical review, which has been essential in enhancing the quality of the work. Sincerely, Miryam Griselda Lora Loza Corresponding Author Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 16 Jun 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 16 Jun 2025 Author Response Dear Dr. Haslinda Ramli, We sincerely appreciate your thoughtful review and constructive comments. In response to your recommendations, we have revised the manuscript as follows: Title Adjustment: The ... Continue reading Dear Dr. Haslinda Ramli, We sincerely appreciate your thoughtful review and constructive comments. In response to your recommendations, we have revised the manuscript as follows: Title Adjustment: The term "impact" was replaced with "relationship" to more accurately reflect the correlational nature of the study, avoiding causal implications inconsistent with our cross-sectional design. Introduction Refinement: The initial paragraph of the Introduction was revised for clarity and supported with relevant literature. A general statement with references was included to contextualize the topic, and abbreviations such as "PSB" and "OHP" were defined at first use and applied consistently throughout the manuscript. Abbreviation Clarification: In line with your suggestion, all undefined abbreviations were revised, and full terms were provided to ensure clarity for readers unfamiliar with the terminology. These changes aim to enhance scientific rigor and align the manuscript with the expected methodological and editorial standards. Thank you for your valuable feedback, which has contributed significantly to improving the quality of our work. Kind regards, Miryam Griselda Lora Loza Corresponding Author Dear Dr. Haslinda Ramli, We sincerely appreciate your thoughtful review and constructive comments. In response to your recommendations, we have revised the manuscript as follows: Title Adjustment: The term "impact" was replaced with "relationship" to more accurately reflect the correlational nature of the study, avoiding causal implications inconsistent with our cross-sectional design. Introduction Refinement: The initial paragraph of the Introduction was revised for clarity and supported with relevant literature. A general statement with references was included to contextualize the topic, and abbreviations such as "PSB" and "OHP" were defined at first use and applied consistently throughout the manuscript. Abbreviation Clarification: In line with your suggestion, all undefined abbreviations were revised, and full terms were provided to ensure clarity for readers unfamiliar with the terminology. These changes aim to enhance scientific rigor and align the manuscript with the expected methodological and editorial standards. Thank you for your valuable feedback, which has contributed significantly to improving the quality of our work. Kind regards, Miryam Griselda Lora Loza Corresponding Author Competing Interests: None declared. Close Report a concern Author Response 15 Jul 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 15 Jul 2025 Author Response Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely ... Continue reading Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely thank Reviewer 2, Dr. Haslinda Ramli, for her insightful and constructive comments. Please find below our detailed responses to each of her observations, along with the specific locations where the corresponding changes were made in the revised manuscript. All modifications are clearly highlighted in the tracked version. 1. Title – Use of "impact" implies causality Comment: The use of “impact” in the title and throughout the manuscript suggests a causal relationship, which is not supported by the cross-sectional design. Response: Thank you for this valuable observation. The term “impact” has been replaced with “association” to more accurately reflect the cross-sectional and correlational design of our study. The new title is: “Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff.” Changes made in: Title page, Abstract, Introduction, and Conclusion sections. 2. Introduction – First sentence implies causality and lacks citation Comment: The opening sentence of the Introduction should avoid implying causation and must be supported by references. Response: We have rewritten the sentence to avoid causal language and included a reference from the World Health Organization (2022) Global Oral Health Report . The revised sentence now reads: “Hospital staff’s perception of their oral health is associated with their overall oral health-related well-being (WHO, 2022).” Changes made in: Introduction, first paragraph. 3. Abbreviation inconsistency Comment: Please clarify the consistent use of abbreviations such as OHP, OHRQoL, and avoid unnecessary acronyms like PSB. Response: We reviewed the entire manuscript and standardized all abbreviations. Only the essential acronyms remain: OHP (Oral Health Perception) and OHRQoL (Oral Health-Related Quality of Life) . All others, including PSB, were removed or clarified at first mention. Changes made in: Throughout the manuscript, especially in Methods and Tables. 4. OHIP-14 classification – Categorical scores require source Comment: The use of qualitative classifications for OHIP-14 (e.g., excellent, poor) needs validation or removal. Response: We agree with the reviewer’s concern. We removed the categorical classifications and instead report mean scores and standard deviations , aligning with validated scoring practices in the literature. Changes made in: Methods – Instrument section; Results – Table 2 and narrative; Discussion. 5. HU-DBI instrument – Invalid reference Comment: The validation reference for the HU-DBI (Cruzado et al., 2024) is invalid or unavailable. Response: The incorrect reference has been removed. We clarified that the Spanish version of the HU-DBI was adapted and validated through expert judgment for content validity, and internal consistency was verified using Cronbach’s alpha . Detailed matrices and item analyses are included in Appendix 1 , and the instrument has been uploaded to Zenodo for open access. Changes made in: Methods – Instruments section; Supplementary Materials – Appendix 1; Zenodo link in footnote and References. DOI: https://doi.org/10.5281/zenodo.15236712 . 6. Sample size and generalization Comment: Please explain the rationale for the sample size and the generalizability of findings. Response: A detailed explanation has been added. The sample size was calculated using G*Power (ρ = 0.30, α = 0.05, power = 0.80), requiring a minimum of 67 participants. We enrolled 72. Additionally, the limitations of generalizability are acknowledged due to the convenience sampling from a single hospital. Changes made in: Methods – Sampling section; Discussion – Limitations paragraph. 7. Confidence intervals in results Comment: Include 95% confidence intervals in correlation and regression results. Response: The Results section now reports 95% confidence intervals for Spearman’s correlations and Nagelkerke’s pseudo R² estimates. This improves statistical transparency and interpretability. Changes made in: Results section – Table 3 and narrative. 8. Clarity of language Comment: Improve language clarity and avoid overgeneralization. Response: The manuscript has undergone a comprehensive language review using Grammarly Premium , ensuring clarity, precision, and academic tone. Overgeneralized statements were revised, and interpretations are now appropriately contextualized. The manuscript adheres to the STROBE guidelines for observational studies. Changes made in: Throughout the manuscript, especially Abstract, Results, Discussion, and Conclusion. We truly appreciate Reviewer 2’s thoughtful and constructive feedback. Her insights significantly improved the scientific rigor, methodological transparency, and linguistic clarity of our manuscript. We are grateful for the opportunity to revise our work accordingly. Respectfully, Dr. Miryam Griselda Lora Loza On behalf of all co-authors Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely thank Reviewer 2, Dr. Haslinda Ramli, for her insightful and constructive comments. Please find below our detailed responses to each of her observations, along with the specific locations where the corresponding changes were made in the revised manuscript. All modifications are clearly highlighted in the tracked version. 1. Title – Use of "impact" implies causality Comment: The use of “impact” in the title and throughout the manuscript suggests a causal relationship, which is not supported by the cross-sectional design. Response: Thank you for this valuable observation. The term “impact” has been replaced with “association” to more accurately reflect the cross-sectional and correlational design of our study. The new title is: “Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff.” Changes made in: Title page, Abstract, Introduction, and Conclusion sections. 2. Introduction – First sentence implies causality and lacks citation Comment: The opening sentence of the Introduction should avoid implying causation and must be supported by references. Response: We have rewritten the sentence to avoid causal language and included a reference from the World Health Organization (2022) Global Oral Health Report . The revised sentence now reads: “Hospital staff’s perception of their oral health is associated with their overall oral health-related well-being (WHO, 2022).” Changes made in: Introduction, first paragraph. 3. Abbreviation inconsistency Comment: Please clarify the consistent use of abbreviations such as OHP, OHRQoL, and avoid unnecessary acronyms like PSB. Response: We reviewed the entire manuscript and standardized all abbreviations. Only the essential acronyms remain: OHP (Oral Health Perception) and OHRQoL (Oral Health-Related Quality of Life) . All others, including PSB, were removed or clarified at first mention. Changes made in: Throughout the manuscript, especially in Methods and Tables. 4. OHIP-14 classification – Categorical scores require source Comment: The use of qualitative classifications for OHIP-14 (e.g., excellent, poor) needs validation or removal. Response: We agree with the reviewer’s concern. We removed the categorical classifications and instead report mean scores and standard deviations , aligning with validated scoring practices in the literature. Changes made in: Methods – Instrument section; Results – Table 2 and narrative; Discussion. 5. HU-DBI instrument – Invalid reference Comment: The validation reference for the HU-DBI (Cruzado et al., 2024) is invalid or unavailable. Response: The incorrect reference has been removed. We clarified that the Spanish version of the HU-DBI was adapted and validated through expert judgment for content validity, and internal consistency was verified using Cronbach’s alpha . Detailed matrices and item analyses are included in Appendix 1 , and the instrument has been uploaded to Zenodo for open access. Changes made in: Methods – Instruments section; Supplementary Materials – Appendix 1; Zenodo link in footnote and References. DOI: https://doi.org/10.5281/zenodo.15236712 . 6. Sample size and generalization Comment: Please explain the rationale for the sample size and the generalizability of findings. Response: A detailed explanation has been added. The sample size was calculated using G*Power (ρ = 0.30, α = 0.05, power = 0.80), requiring a minimum of 67 participants. We enrolled 72. Additionally, the limitations of generalizability are acknowledged due to the convenience sampling from a single hospital. Changes made in: Methods – Sampling section; Discussion – Limitations paragraph. 7. Confidence intervals in results Comment: Include 95% confidence intervals in correlation and regression results. Response: The Results section now reports 95% confidence intervals for Spearman’s correlations and Nagelkerke’s pseudo R² estimates. This improves statistical transparency and interpretability. Changes made in: Results section – Table 3 and narrative. 8. Clarity of language Comment: Improve language clarity and avoid overgeneralization. Response: The manuscript has undergone a comprehensive language review using Grammarly Premium , ensuring clarity, precision, and academic tone. Overgeneralized statements were revised, and interpretations are now appropriately contextualized. The manuscript adheres to the STROBE guidelines for observational studies. Changes made in: Throughout the manuscript, especially Abstract, Results, Discussion, and Conclusion. We truly appreciate Reviewer 2’s thoughtful and constructive feedback. Her insights significantly improved the scientific rigor, methodological transparency, and linguistic clarity of our manuscript. We are grateful for the opportunity to revise our work accordingly. Respectfully, Dr. Miryam Griselda Lora Loza On behalf of all co-authors Competing Interests: The authors declare that there are no competing interests. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 02 May 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 02 May 2025 Author Response Dear Reviewer, Thank you for your valuable feedback and for approving our manuscript with reservations. Each of your thoughtful suggestions has contributed to enhancing the quality and clarity of ... Continue reading Dear Reviewer, Thank you for your valuable feedback and for approving our manuscript with reservations. Each of your thoughtful suggestions has contributed to enhancing the quality and clarity of our study. Below we present our responses to each comment, along with the corresponding actions taken: 1. **Use of the word “Impact” in the title** ➤ *Action taken:* We revised the title to remove any causal implications. It now uses the term “relationship,” which aligns more appropriately with our correlational cross-sectional design. 2. **Abbreviations Consistency** ➤ *Action taken:* The abbreviation “OHP” (Oral Health Perception) has been standardized and used consistently throughout the entire manuscript. 3. **Justification for OHIP-14 Categories** ➤ *Action taken:* We included justification based on prior studies by Espinoza (2017) and Espinoza et al. (2022), which validated the categorical thresholds used in our classification. 4. **HU-DBI Validation** ➤ *Action taken:* We clarified that the HU-DBI instrument was adapted by Midolo (2023) and internally validated by Alvarado and Lora (2024). Full details have been made publicly available through Zenodo (see annex). 5. **Confidence Intervals and Nagelkerke’s R²** ➤ *Action taken:* We included confidence intervals and Nagelkerke’s pseudo R² values in both the results section and the associated tables. 6. **Causal Language in Abstract and Conclusion** ➤ *Action taken:* We revised all instances of causal language, replacing them with neutral expressions that more accurately indicate association or correlation. 7. **English Grammar and Flow** ➤ *Action taken:* The manuscript has undergone a full English language review to improve fluency, readability, and academic tone. 8. **Reference to Cruzado et al. (2024)** ➤ *Action taken:* This reference has been removed, as it was not cited nor included in the final reference list. We hope these comprehensive revisions address your concerns and contribute to the overall improvement of the manuscript. We are grateful for your expert guidance. Sincerely, **Miryam Griselda Lora Loza** (Corresponding Author) Dear Reviewer, Thank you for your valuable feedback and for approving our manuscript with reservations. Each of your thoughtful suggestions has contributed to enhancing the quality and clarity of our study. Below we present our responses to each comment, along with the corresponding actions taken: 1. **Use of the word “Impact” in the title** ➤ *Action taken:* We revised the title to remove any causal implications. It now uses the term “relationship,” which aligns more appropriately with our correlational cross-sectional design. 2. **Abbreviations Consistency** ➤ *Action taken:* The abbreviation “OHP” (Oral Health Perception) has been standardized and used consistently throughout the entire manuscript. 3. **Justification for OHIP-14 Categories** ➤ *Action taken:* We included justification based on prior studies by Espinoza (2017) and Espinoza et al. (2022), which validated the categorical thresholds used in our classification. 4. **HU-DBI Validation** ➤ *Action taken:* We clarified that the HU-DBI instrument was adapted by Midolo (2023) and internally validated by Alvarado and Lora (2024). Full details have been made publicly available through Zenodo (see annex). 5. **Confidence Intervals and Nagelkerke’s R²** ➤ *Action taken:* We included confidence intervals and Nagelkerke’s pseudo R² values in both the results section and the associated tables. 6. **Causal Language in Abstract and Conclusion** ➤ *Action taken:* We revised all instances of causal language, replacing them with neutral expressions that more accurately indicate association or correlation. 7. **English Grammar and Flow** ➤ *Action taken:* The manuscript has undergone a full English language review to improve fluency, readability, and academic tone. 8. **Reference to Cruzado et al. (2024)** ➤ *Action taken:* This reference has been removed, as it was not cited nor included in the final reference list. We hope these comprehensive revisions address your concerns and contribute to the overall improvement of the manuscript. We are grateful for your expert guidance. Sincerely, **Miryam Griselda Lora Loza** (Corresponding Author) Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 15 Jul 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 15 Jul 2025 Author Response Dear Reviewer, We truly appreciate your valuable and detailed feedback on our manuscript. Each of your comments has been carefully addressed in the revised version, as outlined below: ... Continue reading Dear Reviewer, We truly appreciate your valuable and detailed feedback on our manuscript. Each of your comments has been carefully addressed in the revised version, as outlined below: Use of the term “impact” in the title ➤ Action taken: The title has been modified to eliminate any causal language. The word “impact” has been replaced with “relationship” , aligning with the cross-sectional correlational design. Inconsistent use of abbreviations ("OHP" vs. "PSB") ➤ Action taken: All abbreviations have been standardized across the manuscript. We consistently use “OHP” to refer to Oral Health Perception. Lack of justification for OHIP-14 categories ➤ Action taken: We added references to Espinoza (2017) and Espinoza et al. (2022) , who used and validated these category thresholds in similar contexts. HU-DBI validation not clearly cited ➤ Action taken: We clarified that the questionnaire was adapted by Midolo (2023) and validated internally by Alvarado & Lora (2024) . Full instruments and validation details have been published in Zenodo: https://doi.org/10.5281/zenodo.15236712 Lack of Confidence Intervals (CI) and pseudo R² ➤ Action taken: Confidence intervals and Nagelkerke's pseudo R² values have been added in the results and relevant tables. Causal language in the abstract and conclusion ➤ Action taken: All expressions implying causality were removed and replaced with appropriate associative terminology. Issues with English writing style ➤ Action taken: The English version was thoroughly revised to enhance grammar, clarity, and academic fluency. Reference to Cruzado et al. (2024) ➤ Action taken: This reference was deleted, as it was not cited in the body of the text and not included in the final reference list. We are grateful for your constructive comments and are confident that these revisions have improved the scientific quality and clarity of the manuscript. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) [email protected] Dear Reviewer, We truly appreciate your valuable and detailed feedback on our manuscript. Each of your comments has been carefully addressed in the revised version, as outlined below: Use of the term “impact” in the title ➤ Action taken: The title has been modified to eliminate any causal language. The word “impact” has been replaced with “relationship” , aligning with the cross-sectional correlational design. Inconsistent use of abbreviations ("OHP" vs. "PSB") ➤ Action taken: All abbreviations have been standardized across the manuscript. We consistently use “OHP” to refer to Oral Health Perception. Lack of justification for OHIP-14 categories ➤ Action taken: We added references to Espinoza (2017) and Espinoza et al. (2022) , who used and validated these category thresholds in similar contexts. HU-DBI validation not clearly cited ➤ Action taken: We clarified that the questionnaire was adapted by Midolo (2023) and validated internally by Alvarado & Lora (2024) . Full instruments and validation details have been published in Zenodo: https://doi.org/10.5281/zenodo.15236712 Lack of Confidence Intervals (CI) and pseudo R² ➤ Action taken: Confidence intervals and Nagelkerke's pseudo R² values have been added in the results and relevant tables. Causal language in the abstract and conclusion ➤ Action taken: All expressions implying causality were removed and replaced with appropriate associative terminology. Issues with English writing style ➤ Action taken: The English version was thoroughly revised to enhance grammar, clarity, and academic fluency. Reference to Cruzado et al. (2024) ➤ Action taken: This reference was deleted, as it was not cited in the body of the text and not included in the final reference list. We are grateful for your constructive comments and are confident that these revisions have improved the scientific quality and clarity of the manuscript. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) [email protected] Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 02 May 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 02 May 2025 Author Response Dear Reviewer, Haslinda Ramli, Universiti Kebangsaan Malaysia Warm greetings. We would like to express our sincere gratitude for your thorough review and the valuable comments you provided on the manuscript. ... Continue reading Dear Reviewer, Haslinda Ramli, Universiti Kebangsaan Malaysia Warm greetings. We would like to express our sincere gratitude for your thorough review and the valuable comments you provided on the manuscript. Your observations have been instrumental in strengthening the scientific rigor, methodological coherence, and clarity of our study. Below, we outline our responses to each of the points you raised: Use of the term "impact" in the title Action taken: The original title was modified to remove any causal connotation. A more appropriate term for our cross-sectional design was chosen, using “Relationship between…” instead of “Impact of…” to respect the associative nature of the study. Inconsistent use of abbreviations ("OHP" vs. "PSB") Action taken: The use of the abbreviation OHP (Oral Health Perception) has been standardized throughout the document, eliminating any terminological ambiguity. Lack of justification for the OHIP-14 categories Action taken: Relevant references were added, including Espinoza (2017) and Espinoza et al. (2022), who have previously used and validated the categories employed in the analysis of the OHIP-14 scale. Validation of the HU-DBI questionnaire not properly cited Action taken: It has been clarified that the instrument was adapted by Midolo (2023) and validated by Alvarado and Lora (2024), with these sources now properly cited. Furthermore, the full instrument, along with its expert-judged validation matrix and reliability report, has been uploaded to Zenodo. Availability of the full instruments Action taken: Complete versions of the OHIP-14 and HU-DBI (Spanish version) are now publicly available on Zenodo, including the validation matrices, internal reliability analysis, and the anonymized database. Database and statistical results: https://doi.org/10.5281/zenodo.14847738 Methodological annex with instruments and validation: https://doi.org/10.5281/zenodo.15236712 Absence of confidence intervals and fit indicators (pseudo R²) Action taken: Confidence intervals (95% CI) and Nagelkerke's pseudo R² values have been included in the results section and respective tables. Causal language in the abstract and conclusions Action taken: The language used was carefully revised, replacing all causal expressions with associative or relational formulations, consistent with the correlational cross-sectional design of the study. Reference to Cruzado et al. (2024) Action taken: This reference has been removed, as it was not cited in the text and does not appear in the final list of references. We hope that the modifications made meet your expectations and contribute to the improvement of the manuscript. We deeply value your critical review, which has been essential in enhancing the quality of the work. Sincerely, Miryam Griselda Lora Loza Corresponding Author Dear Reviewer, Haslinda Ramli, Universiti Kebangsaan Malaysia Warm greetings. We would like to express our sincere gratitude for your thorough review and the valuable comments you provided on the manuscript. Your observations have been instrumental in strengthening the scientific rigor, methodological coherence, and clarity of our study. Below, we outline our responses to each of the points you raised: Use of the term "impact" in the title Action taken: The original title was modified to remove any causal connotation. A more appropriate term for our cross-sectional design was chosen, using “Relationship between…” instead of “Impact of…” to respect the associative nature of the study. Inconsistent use of abbreviations ("OHP" vs. "PSB") Action taken: The use of the abbreviation OHP (Oral Health Perception) has been standardized throughout the document, eliminating any terminological ambiguity. Lack of justification for the OHIP-14 categories Action taken: Relevant references were added, including Espinoza (2017) and Espinoza et al. (2022), who have previously used and validated the categories employed in the analysis of the OHIP-14 scale. Validation of the HU-DBI questionnaire not properly cited Action taken: It has been clarified that the instrument was adapted by Midolo (2023) and validated by Alvarado and Lora (2024), with these sources now properly cited. Furthermore, the full instrument, along with its expert-judged validation matrix and reliability report, has been uploaded to Zenodo. Availability of the full instruments Action taken: Complete versions of the OHIP-14 and HU-DBI (Spanish version) are now publicly available on Zenodo, including the validation matrices, internal reliability analysis, and the anonymized database. Database and statistical results: https://doi.org/10.5281/zenodo.14847738 Methodological annex with instruments and validation: https://doi.org/10.5281/zenodo.15236712 Absence of confidence intervals and fit indicators (pseudo R²) Action taken: Confidence intervals (95% CI) and Nagelkerke's pseudo R² values have been included in the results section and respective tables. Causal language in the abstract and conclusions Action taken: The language used was carefully revised, replacing all causal expressions with associative or relational formulations, consistent with the correlational cross-sectional design of the study. Reference to Cruzado et al. (2024) Action taken: This reference has been removed, as it was not cited in the text and does not appear in the final list of references. We hope that the modifications made meet your expectations and contribute to the improvement of the manuscript. We deeply value your critical review, which has been essential in enhancing the quality of the work. Sincerely, Miryam Griselda Lora Loza Corresponding Author Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 16 Jun 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 16 Jun 2025 Author Response Dear Dr. Haslinda Ramli, We sincerely appreciate your thoughtful review and constructive comments. In response to your recommendations, we have revised the manuscript as follows: Title Adjustment: The ... Continue reading Dear Dr. Haslinda Ramli, We sincerely appreciate your thoughtful review and constructive comments. In response to your recommendations, we have revised the manuscript as follows: Title Adjustment: The term "impact" was replaced with "relationship" to more accurately reflect the correlational nature of the study, avoiding causal implications inconsistent with our cross-sectional design. Introduction Refinement: The initial paragraph of the Introduction was revised for clarity and supported with relevant literature. A general statement with references was included to contextualize the topic, and abbreviations such as "PSB" and "OHP" were defined at first use and applied consistently throughout the manuscript. Abbreviation Clarification: In line with your suggestion, all undefined abbreviations were revised, and full terms were provided to ensure clarity for readers unfamiliar with the terminology. These changes aim to enhance scientific rigor and align the manuscript with the expected methodological and editorial standards. Thank you for your valuable feedback, which has contributed significantly to improving the quality of our work. Kind regards, Miryam Griselda Lora Loza Corresponding Author Dear Dr. Haslinda Ramli, We sincerely appreciate your thoughtful review and constructive comments. In response to your recommendations, we have revised the manuscript as follows: Title Adjustment: The term "impact" was replaced with "relationship" to more accurately reflect the correlational nature of the study, avoiding causal implications inconsistent with our cross-sectional design. Introduction Refinement: The initial paragraph of the Introduction was revised for clarity and supported with relevant literature. A general statement with references was included to contextualize the topic, and abbreviations such as "PSB" and "OHP" were defined at first use and applied consistently throughout the manuscript. Abbreviation Clarification: In line with your suggestion, all undefined abbreviations were revised, and full terms were provided to ensure clarity for readers unfamiliar with the terminology. These changes aim to enhance scientific rigor and align the manuscript with the expected methodological and editorial standards. Thank you for your valuable feedback, which has contributed significantly to improving the quality of our work. Kind regards, Miryam Griselda Lora Loza Corresponding Author Competing Interests: None declared. Close Report a concern Author Response 15 Jul 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 15 Jul 2025 Author Response Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely ... Continue reading Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely thank Reviewer 2, Dr. Haslinda Ramli, for her insightful and constructive comments. Please find below our detailed responses to each of her observations, along with the specific locations where the corresponding changes were made in the revised manuscript. All modifications are clearly highlighted in the tracked version. 1. Title – Use of "impact" implies causality Comment: The use of “impact” in the title and throughout the manuscript suggests a causal relationship, which is not supported by the cross-sectional design. Response: Thank you for this valuable observation. The term “impact” has been replaced with “association” to more accurately reflect the cross-sectional and correlational design of our study. The new title is: “Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff.” Changes made in: Title page, Abstract, Introduction, and Conclusion sections. 2. Introduction – First sentence implies causality and lacks citation Comment: The opening sentence of the Introduction should avoid implying causation and must be supported by references. Response: We have rewritten the sentence to avoid causal language and included a reference from the World Health Organization (2022) Global Oral Health Report . The revised sentence now reads: “Hospital staff’s perception of their oral health is associated with their overall oral health-related well-being (WHO, 2022).” Changes made in: Introduction, first paragraph. 3. Abbreviation inconsistency Comment: Please clarify the consistent use of abbreviations such as OHP, OHRQoL, and avoid unnecessary acronyms like PSB. Response: We reviewed the entire manuscript and standardized all abbreviations. Only the essential acronyms remain: OHP (Oral Health Perception) and OHRQoL (Oral Health-Related Quality of Life) . All others, including PSB, were removed or clarified at first mention. Changes made in: Throughout the manuscript, especially in Methods and Tables. 4. OHIP-14 classification – Categorical scores require source Comment: The use of qualitative classifications for OHIP-14 (e.g., excellent, poor) needs validation or removal. Response: We agree with the reviewer’s concern. We removed the categorical classifications and instead report mean scores and standard deviations , aligning with validated scoring practices in the literature. Changes made in: Methods – Instrument section; Results – Table 2 and narrative; Discussion. 5. HU-DBI instrument – Invalid reference Comment: The validation reference for the HU-DBI (Cruzado et al., 2024) is invalid or unavailable. Response: The incorrect reference has been removed. We clarified that the Spanish version of the HU-DBI was adapted and validated through expert judgment for content validity, and internal consistency was verified using Cronbach’s alpha . Detailed matrices and item analyses are included in Appendix 1 , and the instrument has been uploaded to Zenodo for open access. Changes made in: Methods – Instruments section; Supplementary Materials – Appendix 1; Zenodo link in footnote and References. DOI: https://doi.org/10.5281/zenodo.15236712 . 6. Sample size and generalization Comment: Please explain the rationale for the sample size and the generalizability of findings. Response: A detailed explanation has been added. The sample size was calculated using G*Power (ρ = 0.30, α = 0.05, power = 0.80), requiring a minimum of 67 participants. We enrolled 72. Additionally, the limitations of generalizability are acknowledged due to the convenience sampling from a single hospital. Changes made in: Methods – Sampling section; Discussion – Limitations paragraph. 7. Confidence intervals in results Comment: Include 95% confidence intervals in correlation and regression results. Response: The Results section now reports 95% confidence intervals for Spearman’s correlations and Nagelkerke’s pseudo R² estimates. This improves statistical transparency and interpretability. Changes made in: Results section – Table 3 and narrative. 8. Clarity of language Comment: Improve language clarity and avoid overgeneralization. Response: The manuscript has undergone a comprehensive language review using Grammarly Premium , ensuring clarity, precision, and academic tone. Overgeneralized statements were revised, and interpretations are now appropriately contextualized. The manuscript adheres to the STROBE guidelines for observational studies. Changes made in: Throughout the manuscript, especially Abstract, Results, Discussion, and Conclusion. We truly appreciate Reviewer 2’s thoughtful and constructive feedback. Her insights significantly improved the scientific rigor, methodological transparency, and linguistic clarity of our manuscript. We are grateful for the opportunity to revise our work accordingly. Respectfully, Dr. Miryam Griselda Lora Loza On behalf of all co-authors Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely thank Reviewer 2, Dr. Haslinda Ramli, for her insightful and constructive comments. Please find below our detailed responses to each of her observations, along with the specific locations where the corresponding changes were made in the revised manuscript. All modifications are clearly highlighted in the tracked version. 1. Title – Use of "impact" implies causality Comment: The use of “impact” in the title and throughout the manuscript suggests a causal relationship, which is not supported by the cross-sectional design. Response: Thank you for this valuable observation. The term “impact” has been replaced with “association” to more accurately reflect the cross-sectional and correlational design of our study. The new title is: “Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff.” Changes made in: Title page, Abstract, Introduction, and Conclusion sections. 2. Introduction – First sentence implies causality and lacks citation Comment: The opening sentence of the Introduction should avoid implying causation and must be supported by references. Response: We have rewritten the sentence to avoid causal language and included a reference from the World Health Organization (2022) Global Oral Health Report . The revised sentence now reads: “Hospital staff’s perception of their oral health is associated with their overall oral health-related well-being (WHO, 2022).” Changes made in: Introduction, first paragraph. 3. Abbreviation inconsistency Comment: Please clarify the consistent use of abbreviations such as OHP, OHRQoL, and avoid unnecessary acronyms like PSB. Response: We reviewed the entire manuscript and standardized all abbreviations. Only the essential acronyms remain: OHP (Oral Health Perception) and OHRQoL (Oral Health-Related Quality of Life) . All others, including PSB, were removed or clarified at first mention. Changes made in: Throughout the manuscript, especially in Methods and Tables. 4. OHIP-14 classification – Categorical scores require source Comment: The use of qualitative classifications for OHIP-14 (e.g., excellent, poor) needs validation or removal. Response: We agree with the reviewer’s concern. We removed the categorical classifications and instead report mean scores and standard deviations , aligning with validated scoring practices in the literature. Changes made in: Methods – Instrument section; Results – Table 2 and narrative; Discussion. 5. HU-DBI instrument – Invalid reference Comment: The validation reference for the HU-DBI (Cruzado et al., 2024) is invalid or unavailable. Response: The incorrect reference has been removed. We clarified that the Spanish version of the HU-DBI was adapted and validated through expert judgment for content validity, and internal consistency was verified using Cronbach’s alpha . Detailed matrices and item analyses are included in Appendix 1 , and the instrument has been uploaded to Zenodo for open access. Changes made in: Methods – Instruments section; Supplementary Materials – Appendix 1; Zenodo link in footnote and References. DOI: https://doi.org/10.5281/zenodo.15236712 . 6. Sample size and generalization Comment: Please explain the rationale for the sample size and the generalizability of findings. Response: A detailed explanation has been added. The sample size was calculated using G*Power (ρ = 0.30, α = 0.05, power = 0.80), requiring a minimum of 67 participants. We enrolled 72. Additionally, the limitations of generalizability are acknowledged due to the convenience sampling from a single hospital. Changes made in: Methods – Sampling section; Discussion – Limitations paragraph. 7. Confidence intervals in results Comment: Include 95% confidence intervals in correlation and regression results. Response: The Results section now reports 95% confidence intervals for Spearman’s correlations and Nagelkerke’s pseudo R² estimates. This improves statistical transparency and interpretability. Changes made in: Results section – Table 3 and narrative. 8. Clarity of language Comment: Improve language clarity and avoid overgeneralization. Response: The manuscript has undergone a comprehensive language review using Grammarly Premium , ensuring clarity, precision, and academic tone. Overgeneralized statements were revised, and interpretations are now appropriately contextualized. The manuscript adheres to the STROBE guidelines for observational studies. Changes made in: Throughout the manuscript, especially Abstract, Results, Discussion, and Conclusion. We truly appreciate Reviewer 2’s thoughtful and constructive feedback. Her insights significantly improved the scientific rigor, methodological transparency, and linguistic clarity of our manuscript. We are grateful for the opportunity to revise our work accordingly. Respectfully, Dr. Miryam Griselda Lora Loza On behalf of all co-authors Competing Interests: The authors declare that there are no competing interests. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Asiri FYI. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.177142.r368811 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v1#referee-response-368811 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 31 Mar 2025 Faris Yahya I Asiri , King Faisal University, Al-Ahsa, Saudi Arabia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.177142.r368811 This manuscript explores the association between oral health perception (OHP) and quality of life (QoL) among hospital staff in northern Peru. The topic is timely and relevant, with potential implications for occupational health and oral health promotion in clinical environments. ... Continue reading READ ALL This manuscript explores the association between oral health perception (OHP) and quality of life (QoL) among hospital staff in northern Peru. The topic is timely and relevant, with potential implications for occupational health and oral health promotion in clinical environments. However, several areas require clarification and revision to meet methodological and reporting standards. 1. Introduction and Use of Literature The manuscript references global challenges in oral health but supports several key claims using regionally limited or non-peer-reviewed sources. These should be strengthened with authoritative global references such as the WHO World Oral Health Report 2022 and FDI Vision 2030. Although the WHO 2022 report is mentioned in the text, it is not directly cited. This should be corrected. The manuscript references multiple SDGs beyond SDG 3 (e.g., SDG 6, 10, 11) without explaining their relevance. These references should be substantiated with literature or omitted. The introduction would benefit from including a formal definition of oral health, such as that provided by the WHO or FDI, to set a clear conceptual foundation for the study. 2. Methodological Issues The study is described as “correlational–causal,” and the results section repeatedly uses causal language (e.g., “impact,” “influence”). However, the cross-sectional design precludes causal inference. The language should be revised to reflect associative relationships. The manuscript lacks a sample size justification or power analysis. Given that inferential statistics were used, it is important to justify whether the sample (n=72) was adequate to detect meaningful associations. 3. Instruments and Transparency The classification of OHIP-14 results into categories such as “excellent,” “average,” and “poor” is not part of the original instrument. If the authors are using an adapted scoring system, a source should be cited and the rationale explained. Otherwise, the standard scoring system should be used. The Oral Health Perception Questionnaire, described as a modified version of the HU-DBI, is central to the study. However, the cited validation by Cruzado et al. (2024) is not found in the reference list. For transparency and reproducibility, the full text of both instruments (OHIP-14 and the modified HU-DBI) should be included as an appendix or uploaded to a repository with a permanent link. 4. Statistical Reporting and Interpretation The statistical tests used (Spearman correlation and ordinal logistic regression) are appropriate given the data distribution. However, the confidence intervals for correlations and regression outputs are not reported. Including CIs would help readers assess the precision of estimates. Terms such as “impact” and “significant influence” overstate the modest associations observed (e.g., r = 0.391). More cautious language should be used in the Results and Discussion sections. 5. Discussion and Conclusion The discussion and conclusions sections overstate the implications of the findings. Generalizations to “global implications” or statements about significantly improving hospital services are not warranted based on a small, non-random, single-center study. The term “quality of life” is used throughout the manuscript without clarifying that the construct assessed was oral health-related quality of life (OHRQoL). This should be clarified to avoid misinterpretation. 6. References Key references are missing, including the WHO World Oral Health Report 2022, and the Cruzado et al. (2024) validation paper. These should be added. Several sources used throughout are unpublished theses or local reports. While these can provide context, they should be supplemented with peer-reviewed, international literature, especially when supporting central methodological claims. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Oral Health Research, Dental Public Health, Oral Epidemiology, Special Care Dentistry, Oral Health-Related Quality of Life, Health Promotion I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Asiri FYI. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.177142.r368811 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v1#referee-response-368811 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 02 May 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 02 May 2025 Author Response Dear Reviewer, We sincerely appreciate the valuable comments and suggestions made regarding our manuscript entitled "Impact of Oral Health Perception on the Quality of Life of Hospital Staff" . We have ... Continue reading Dear Reviewer, We sincerely appreciate the valuable comments and suggestions made regarding our manuscript entitled "Impact of Oral Health Perception on the Quality of Life of Hospital Staff" . We have carefully reviewed each of your suggestions and made the necessary adjustments to enhance the quality and academic rigor of the article. Below, we present our detailed responses to your observations. 1. Introduction and Use of Literature: We appreciate your suggestion to strengthen the theoretical foundation with global references. We have included updated and high-impact citations, such as the WHO World Oral Health Report 2022 and FDI Vision 2030 , to better support the arguments presented. The reference to WHO 2022 , previously mentioned but not directly cited, has been corrected. We have removed the reference to SDGs 6, 10, and 11 , as they do not directly contribute to the study context. Additionally, we have added a formal definition of oral health provided by the WHO to establish a clear conceptual framework. 2. Methodological Issues: We acknowledge the inappropriate use of causal terms such as "impact" and "influence" within the context of a correlational design. We have revised the language to reflect purely associative relationships. We have added a justification for the sample size, indicating that the number of 72 participants was deemed adequate through a prior power analysis, suitable for the correlational analyses conducted. 3. Instruments and Transparency: We appreciate the observation regarding the classification of OHIP-14 . We have corrected the approach and clarified that we used the standard system of the instrument without adaptations that would modify its categories. Regarding the reference to Cruzado et al. (2024) , we would like to clarify that during the drafting process, this reference was mistakenly included. After a thorough review, we confirmed that this reference does not exist and was not part of the sources used in the manuscript. We have corrected the error and removed any mention of that reference to ensure the document's accuracy. Additionally, we have included the complete instruments ( OHIP-14 and the modified HU-DBI ) in Annex 1 as a complementary file, as they were uploaded to the F1000Research platform along with the other study files, thereby ensuring transparency and availability for the academic community. 4. Statistical Reporting and Interpretation: We have added the corresponding confidence intervals (CIs) for the correlations and regressions presented to improve the precision of the results interpretation. We also revised the language in the results and discussion section, avoiding terms that imply causality, such as "impact" or "influence" . 5. Discussion and Conclusion: We adjusted the tone of the discussion to avoid generalizations that are not justified, considering the sample size and the specific context of the study. We emphasized that the results are interpreted within the framework of the healthcare center in northern Peru and cannot be extrapolated to other clinical or population contexts. Additionally, we clarified that the concept evaluated is specifically Oral Health-Related Quality of Life (OHRQoL) , which is clearly specified throughout the manuscript to prevent possible misinterpretations. 6. References: We have added the key references suggested, including the WHO World Oral Health Report 2022 and Vision 2030: Delivering Optimal Oral Health for All . Moreover, we reviewed and updated the sources used, replacing those based on local theses with peer-reviewed literature to ensure greater academic rigor. Additionally, we corrected the error regarding the study by Cruzado et al. (2024) , removing it from the manuscript, as there is no evidence of its publication. We once again appreciate your dedication to reviewing our manuscript. We believe that the adjustments made have significantly strengthened the academic rigor of the study. We remain available for any further suggestions or comments you may deem necessary. Sincerely, Miryam Griselda Lora Loza and co-authors. Dear Reviewer, We sincerely appreciate the valuable comments and suggestions made regarding our manuscript entitled "Impact of Oral Health Perception on the Quality of Life of Hospital Staff" . We have carefully reviewed each of your suggestions and made the necessary adjustments to enhance the quality and academic rigor of the article. Below, we present our detailed responses to your observations. 1. Introduction and Use of Literature: We appreciate your suggestion to strengthen the theoretical foundation with global references. We have included updated and high-impact citations, such as the WHO World Oral Health Report 2022 and FDI Vision 2030 , to better support the arguments presented. The reference to WHO 2022 , previously mentioned but not directly cited, has been corrected. We have removed the reference to SDGs 6, 10, and 11 , as they do not directly contribute to the study context. Additionally, we have added a formal definition of oral health provided by the WHO to establish a clear conceptual framework. 2. Methodological Issues: We acknowledge the inappropriate use of causal terms such as "impact" and "influence" within the context of a correlational design. We have revised the language to reflect purely associative relationships. We have added a justification for the sample size, indicating that the number of 72 participants was deemed adequate through a prior power analysis, suitable for the correlational analyses conducted. 3. Instruments and Transparency: We appreciate the observation regarding the classification of OHIP-14 . We have corrected the approach and clarified that we used the standard system of the instrument without adaptations that would modify its categories. Regarding the reference to Cruzado et al. (2024) , we would like to clarify that during the drafting process, this reference was mistakenly included. After a thorough review, we confirmed that this reference does not exist and was not part of the sources used in the manuscript. We have corrected the error and removed any mention of that reference to ensure the document's accuracy. Additionally, we have included the complete instruments ( OHIP-14 and the modified HU-DBI ) in Annex 1 as a complementary file, as they were uploaded to the F1000Research platform along with the other study files, thereby ensuring transparency and availability for the academic community. 4. Statistical Reporting and Interpretation: We have added the corresponding confidence intervals (CIs) for the correlations and regressions presented to improve the precision of the results interpretation. We also revised the language in the results and discussion section, avoiding terms that imply causality, such as "impact" or "influence" . 5. Discussion and Conclusion: We adjusted the tone of the discussion to avoid generalizations that are not justified, considering the sample size and the specific context of the study. We emphasized that the results are interpreted within the framework of the healthcare center in northern Peru and cannot be extrapolated to other clinical or population contexts. Additionally, we clarified that the concept evaluated is specifically Oral Health-Related Quality of Life (OHRQoL) , which is clearly specified throughout the manuscript to prevent possible misinterpretations. 6. References: We have added the key references suggested, including the WHO World Oral Health Report 2022 and Vision 2030: Delivering Optimal Oral Health for All . Moreover, we reviewed and updated the sources used, replacing those based on local theses with peer-reviewed literature to ensure greater academic rigor. Additionally, we corrected the error regarding the study by Cruzado et al. (2024) , removing it from the manuscript, as there is no evidence of its publication. We once again appreciate your dedication to reviewing our manuscript. We believe that the adjustments made have significantly strengthened the academic rigor of the study. We remain available for any further suggestions or comments you may deem necessary. Sincerely, Miryam Griselda Lora Loza and co-authors. Competing Interests: No competing interests were disclosed Close Report a concern Author Response 02 May 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 02 May 2025 Author Response Dear Reviewer, We sincerely appreciate your thorough review and constructive feedback on our manuscript. Below we detail how each of your observations has been addressed in the revised version: ... Continue reading Dear Reviewer, We sincerely appreciate your thorough review and constructive feedback on our manuscript. Below we detail how each of your observations has been addressed in the revised version: Use of Literature and International Sources ➤ Action taken: We expanded the literature review by integrating key international sources, including the WHO World Oral Health Report 2022 , FDI Vision 2030 , UNESCO , and UNDP documents to provide a stronger global perspective on oral health policy and inequality. Definition of Oral Health ➤ Action taken: The WHO's formal definition of oral health has been incorporated in the Introduction to frame the central concept more precisely. Use of the term “correlational-causal” ➤ Action taken: The term was completely removed. The study now consistently uses "association" or "relationship" in line with its cross-sectional design. Sample Size Justification ➤ Action taken: We added a justification using G*Power software (effect size ρ = 0.30, α = 0.05, power = 0.80), which supports the adequacy of the sample size (n = 72). Availability of Full Instruments ➤ Action taken: The full versions of the OHIP-14 and HU-DBI questionnaires (Spanish versions), along with the expert validation matrix and reliability metrics, have been uploaded to Zenodo . Links: Dataset: https://doi.org/10.5281/zenodo.14847738 Methodological annex: https://doi.org/10.5281/zenodo.15236712 Overstatement and Global Generalization ➤ Action taken: We revised the Discussion and Conclusion to better acknowledge methodological limitations and avoid overgeneralizing findings beyond the local context. Clarification between General QoL and OHRQoL ➤ Action taken: The construct of Oral Health-Related Quality of Life (OHRQoL) has been explicitly defined and distinguished from general quality of life (QoL), reinforcing its role as the dependent variable. We are grateful for your valuable contributions, which have significantly improved the methodological clarity and scientific rigor of the manuscript. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) Dear Reviewer, We sincerely appreciate your thorough review and constructive feedback on our manuscript. Below we detail how each of your observations has been addressed in the revised version: Use of Literature and International Sources ➤ Action taken: We expanded the literature review by integrating key international sources, including the WHO World Oral Health Report 2022 , FDI Vision 2030 , UNESCO , and UNDP documents to provide a stronger global perspective on oral health policy and inequality. Definition of Oral Health ➤ Action taken: The WHO's formal definition of oral health has been incorporated in the Introduction to frame the central concept more precisely. Use of the term “correlational-causal” ➤ Action taken: The term was completely removed. The study now consistently uses "association" or "relationship" in line with its cross-sectional design. Sample Size Justification ➤ Action taken: We added a justification using G*Power software (effect size ρ = 0.30, α = 0.05, power = 0.80), which supports the adequacy of the sample size (n = 72). Availability of Full Instruments ➤ Action taken: The full versions of the OHIP-14 and HU-DBI questionnaires (Spanish versions), along with the expert validation matrix and reliability metrics, have been uploaded to Zenodo . Links: Dataset: https://doi.org/10.5281/zenodo.14847738 Methodological annex: https://doi.org/10.5281/zenodo.15236712 Overstatement and Global Generalization ➤ Action taken: We revised the Discussion and Conclusion to better acknowledge methodological limitations and avoid overgeneralizing findings beyond the local context. Clarification between General QoL and OHRQoL ➤ Action taken: The construct of Oral Health-Related Quality of Life (OHRQoL) has been explicitly defined and distinguished from general quality of life (QoL), reinforcing its role as the dependent variable. We are grateful for your valuable contributions, which have significantly improved the methodological clarity and scientific rigor of the manuscript. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 07 May 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 07 May 2025 Author Response Dear Reviewer, Faris Yahya I. Asiri King Faisal University, Saudi Arabia We are sincerely grateful for your thorough review and constructive recommendations. Your observations have significantly contributed to the scientific ... Continue reading Dear Reviewer, Faris Yahya I. Asiri King Faisal University, Saudi Arabia We are sincerely grateful for your thorough review and constructive recommendations. Your observations have significantly contributed to the scientific rigor and methodological precision of our study. Below, we detail our responses to each point raised: Use of Literature and International Sources ➤ Action taken: We expanded the literature review by integrating key international references, including the WHO World Oral Health Report 2022 , FDI Vision 2030 , UNESCO , and UNDP . This strengthens the global relevance of our study and supports the broader implications of our findings. Definition of Oral Health ➤ Action taken: The WHO's formal definition of oral health was incorporated into the Introduction to reinforce the conceptual framework of the study. Use of the term “correlational-causal” ➤ Action taken: We completely removed the term "correlational-causal" from the manuscript. Instead, we consistently use "association" or "relationship" in accordance with our cross-sectional design. Sample Size Justification ➤ Action taken: We added a sample size justification using GPower software (effect size ρ = 0.30, α = 0.05, power = 80%), supporting the adequacy of the chosen sample (n = 72). Availability of Full Instruments ➤ Action taken: The complete versions of the OHIP-14 and HU-DBI (Spanish version) were uploaded to Zenodo, along with their validation matrices and reliability reports. Dataset: https://doi.org/10.5281/zenodo.14847738 Methodological Annex: https://doi.org/10.5281/zenodo.15236712 Overstatement and Global Generalization ➤ Action taken: We revised the Discussion and Conclusion sections to avoid overgeneralizing results. We emphasized the local scope and acknowledged methodological limitations. Clarification between General QoL and OHRQoL ➤ Action taken: We explicitly distinguished Oral Health-Related Quality of Life (OHRQoL) from general Quality of Life (QoL), clarifying its role as the dependent variable in our analysis. Title Modification ➤ Action taken: In response to your and Reviewer 1’s suggestions, the original title “Impact of oral health perception on quality of life” was revised to: “Relationship between the perception of oral health and the quality of life of hospital staff” , in order to better reflect the non-causal, correlational nature of the study. We trust these revisions meet your expectations and contribute to the improved quality and clarity of the manuscript. Once again, we thank you for your valuable insights and support. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) Dear Reviewer, Faris Yahya I. Asiri King Faisal University, Saudi Arabia We are sincerely grateful for your thorough review and constructive recommendations. Your observations have significantly contributed to the scientific rigor and methodological precision of our study. Below, we detail our responses to each point raised: Use of Literature and International Sources ➤ Action taken: We expanded the literature review by integrating key international references, including the WHO World Oral Health Report 2022 , FDI Vision 2030 , UNESCO , and UNDP . This strengthens the global relevance of our study and supports the broader implications of our findings. Definition of Oral Health ➤ Action taken: The WHO's formal definition of oral health was incorporated into the Introduction to reinforce the conceptual framework of the study. Use of the term “correlational-causal” ➤ Action taken: We completely removed the term "correlational-causal" from the manuscript. Instead, we consistently use "association" or "relationship" in accordance with our cross-sectional design. Sample Size Justification ➤ Action taken: We added a sample size justification using GPower software (effect size ρ = 0.30, α = 0.05, power = 80%), supporting the adequacy of the chosen sample (n = 72). Availability of Full Instruments ➤ Action taken: The complete versions of the OHIP-14 and HU-DBI (Spanish version) were uploaded to Zenodo, along with their validation matrices and reliability reports. Dataset: https://doi.org/10.5281/zenodo.14847738 Methodological Annex: https://doi.org/10.5281/zenodo.15236712 Overstatement and Global Generalization ➤ Action taken: We revised the Discussion and Conclusion sections to avoid overgeneralizing results. We emphasized the local scope and acknowledged methodological limitations. Clarification between General QoL and OHRQoL ➤ Action taken: We explicitly distinguished Oral Health-Related Quality of Life (OHRQoL) from general Quality of Life (QoL), clarifying its role as the dependent variable in our analysis. Title Modification ➤ Action taken: In response to your and Reviewer 1’s suggestions, the original title “Impact of oral health perception on quality of life” was revised to: “Relationship between the perception of oral health and the quality of life of hospital staff” , in order to better reflect the non-causal, correlational nature of the study. We trust these revisions meet your expectations and contribute to the improved quality and clarity of the manuscript. Once again, we thank you for your valuable insights and support. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 15 Jul 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 15 Jul 2025 Author Response Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely thank ... Continue reading Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely thank Reviewer 1, Dr. Faris Yahya I. Asiri, for his constructive and thoughtful observations. Below, we provide detailed responses to each of his comments, along with the specific sections where changes were made in the revised manuscript. All edits are clearly marked in the tracked version. 1. Study objectives and rationale – Clarify the purpose and design Comment: The objective of the study and the rationale need to be more clearly presented in the introduction and methods. Response: We appreciate this valuable observation. The objective was reformulated to explicitly state that the study aims to examine the association between oral health perception and oral health-related quality of life (OHRQoL) among hospital staff. We also clarified the study design as correlational and cross-sectional in both the Introduction and the Methods sections. Changes made in: Introduction (last paragraph), Methods – Design subsection. 2. Sampling method and population – Explain selection criteria Comment: Please provide more details about the population selection and inclusion/exclusion criteria. Response: We added detailed information about the inclusion and exclusion criteria and specified that the sample was selected by non-probabilistic convenience sampling from staff working at a level II hospital in northern Peru. The rationale for this selection was also explained. Changes made in: Methods – Population and Sampling section. 3. Instruments – Provide psychometric information Comment: More information is needed on the validity and reliability of the instruments used. Response: We provided complete psychometric information for both the OHIP-14 and HU-DBI instruments. The OHIP-14 has been widely validated in Spanish-speaking populations. For the HU-DBI, we clarified that its Spanish version was adapted through expert judgment for content validity, and internal consistency was calculated using Cronbach’s alpha. All related evidence and matrices are now available in Appendix 1 and open-access via Zenodo. Changes made in: Methods – Instruments subsection; Supplementary Appendix 1; References (Zenodo DOI: https://doi.org/10.5281/zenodo.15236712 ). 4. Statistical analysis – More clarity needed Comment: Clarify how the variables were analyzed and justify the tests used. Response: We improved the description of the statistical analysis. We explained the use of Spearman’s correlation due to non-normal data distribution, and logistic regression to explore the association between OHP and OHRQoL domains. Confidence intervals (95%) were added to support the strength and precision of the results. Changes made in: Methods – Data Analysis subsection; Results – Table 3 and text. 5. Interpretation of findings – Avoid causal language Comment: The interpretation of findings should not suggest causality in a cross-sectional design. Response: We revised the Discussion and Conclusion sections to avoid any causal implications, consistently using associative and correlational terminology. We acknowledge the limitations of cross-sectional studies and emphasized the need for further longitudinal research. Changes made in: Discussion and Conclusion sections. 6. Ethical considerations – Add details on approvals Comment: Please confirm ethical approval and participant consent. Response: We added that the study received ethical approval from the Institutional Ethics Committee of Universidad César Vallejo (Approval No. 007-2025-CEI), and that written informed consent was obtained from all participants in accordance with the Declaration of Helsinki. Changes made in: Methods – Ethical Considerations subsection. We thank Reviewer 1 for his invaluable contributions. His remarks allowed us to strengthen the scientific robustness, ethical transparency, and methodological consistency of our study. Respectfully, Dr. Miryam Griselda Lora Loza On behalf of all co-authors Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely thank Reviewer 1, Dr. Faris Yahya I. Asiri, for his constructive and thoughtful observations. Below, we provide detailed responses to each of his comments, along with the specific sections where changes were made in the revised manuscript. All edits are clearly marked in the tracked version. 1. Study objectives and rationale – Clarify the purpose and design Comment: The objective of the study and the rationale need to be more clearly presented in the introduction and methods. Response: We appreciate this valuable observation. The objective was reformulated to explicitly state that the study aims to examine the association between oral health perception and oral health-related quality of life (OHRQoL) among hospital staff. We also clarified the study design as correlational and cross-sectional in both the Introduction and the Methods sections. Changes made in: Introduction (last paragraph), Methods – Design subsection. 2. Sampling method and population – Explain selection criteria Comment: Please provide more details about the population selection and inclusion/exclusion criteria. Response: We added detailed information about the inclusion and exclusion criteria and specified that the sample was selected by non-probabilistic convenience sampling from staff working at a level II hospital in northern Peru. The rationale for this selection was also explained. Changes made in: Methods – Population and Sampling section. 3. Instruments – Provide psychometric information Comment: More information is needed on the validity and reliability of the instruments used. Response: We provided complete psychometric information for both the OHIP-14 and HU-DBI instruments. The OHIP-14 has been widely validated in Spanish-speaking populations. For the HU-DBI, we clarified that its Spanish version was adapted through expert judgment for content validity, and internal consistency was calculated using Cronbach’s alpha. All related evidence and matrices are now available in Appendix 1 and open-access via Zenodo. Changes made in: Methods – Instruments subsection; Supplementary Appendix 1; References (Zenodo DOI: https://doi.org/10.5281/zenodo.15236712 ). 4. Statistical analysis – More clarity needed Comment: Clarify how the variables were analyzed and justify the tests used. Response: We improved the description of the statistical analysis. We explained the use of Spearman’s correlation due to non-normal data distribution, and logistic regression to explore the association between OHP and OHRQoL domains. Confidence intervals (95%) were added to support the strength and precision of the results. Changes made in: Methods – Data Analysis subsection; Results – Table 3 and text. 5. Interpretation of findings – Avoid causal language Comment: The interpretation of findings should not suggest causality in a cross-sectional design. Response: We revised the Discussion and Conclusion sections to avoid any causal implications, consistently using associative and correlational terminology. We acknowledge the limitations of cross-sectional studies and emphasized the need for further longitudinal research. Changes made in: Discussion and Conclusion sections. 6. Ethical considerations – Add details on approvals Comment: Please confirm ethical approval and participant consent. Response: We added that the study received ethical approval from the Institutional Ethics Committee of Universidad César Vallejo (Approval No. 007-2025-CEI), and that written informed consent was obtained from all participants in accordance with the Declaration of Helsinki. Changes made in: Methods – Ethical Considerations subsection. We thank Reviewer 1 for his invaluable contributions. His remarks allowed us to strengthen the scientific robustness, ethical transparency, and methodological consistency of our study. Respectfully, Dr. Miryam Griselda Lora Loza On behalf of all co-authors Competing Interests: The authors declare that there are no competing interests. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 02 May 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 02 May 2025 Author Response Dear Reviewer, We sincerely appreciate the valuable comments and suggestions made regarding our manuscript entitled "Impact of Oral Health Perception on the Quality of Life of Hospital Staff" . We have ... Continue reading Dear Reviewer, We sincerely appreciate the valuable comments and suggestions made regarding our manuscript entitled "Impact of Oral Health Perception on the Quality of Life of Hospital Staff" . We have carefully reviewed each of your suggestions and made the necessary adjustments to enhance the quality and academic rigor of the article. Below, we present our detailed responses to your observations. 1. Introduction and Use of Literature: We appreciate your suggestion to strengthen the theoretical foundation with global references. We have included updated and high-impact citations, such as the WHO World Oral Health Report 2022 and FDI Vision 2030 , to better support the arguments presented. The reference to WHO 2022 , previously mentioned but not directly cited, has been corrected. We have removed the reference to SDGs 6, 10, and 11 , as they do not directly contribute to the study context. Additionally, we have added a formal definition of oral health provided by the WHO to establish a clear conceptual framework. 2. Methodological Issues: We acknowledge the inappropriate use of causal terms such as "impact" and "influence" within the context of a correlational design. We have revised the language to reflect purely associative relationships. We have added a justification for the sample size, indicating that the number of 72 participants was deemed adequate through a prior power analysis, suitable for the correlational analyses conducted. 3. Instruments and Transparency: We appreciate the observation regarding the classification of OHIP-14 . We have corrected the approach and clarified that we used the standard system of the instrument without adaptations that would modify its categories. Regarding the reference to Cruzado et al. (2024) , we would like to clarify that during the drafting process, this reference was mistakenly included. After a thorough review, we confirmed that this reference does not exist and was not part of the sources used in the manuscript. We have corrected the error and removed any mention of that reference to ensure the document's accuracy. Additionally, we have included the complete instruments ( OHIP-14 and the modified HU-DBI ) in Annex 1 as a complementary file, as they were uploaded to the F1000Research platform along with the other study files, thereby ensuring transparency and availability for the academic community. 4. Statistical Reporting and Interpretation: We have added the corresponding confidence intervals (CIs) for the correlations and regressions presented to improve the precision of the results interpretation. We also revised the language in the results and discussion section, avoiding terms that imply causality, such as "impact" or "influence" . 5. Discussion and Conclusion: We adjusted the tone of the discussion to avoid generalizations that are not justified, considering the sample size and the specific context of the study. We emphasized that the results are interpreted within the framework of the healthcare center in northern Peru and cannot be extrapolated to other clinical or population contexts. Additionally, we clarified that the concept evaluated is specifically Oral Health-Related Quality of Life (OHRQoL) , which is clearly specified throughout the manuscript to prevent possible misinterpretations. 6. References: We have added the key references suggested, including the WHO World Oral Health Report 2022 and Vision 2030: Delivering Optimal Oral Health for All . Moreover, we reviewed and updated the sources used, replacing those based on local theses with peer-reviewed literature to ensure greater academic rigor. Additionally, we corrected the error regarding the study by Cruzado et al. (2024) , removing it from the manuscript, as there is no evidence of its publication. We once again appreciate your dedication to reviewing our manuscript. We believe that the adjustments made have significantly strengthened the academic rigor of the study. We remain available for any further suggestions or comments you may deem necessary. Sincerely, Miryam Griselda Lora Loza and co-authors. Dear Reviewer, We sincerely appreciate the valuable comments and suggestions made regarding our manuscript entitled "Impact of Oral Health Perception on the Quality of Life of Hospital Staff" . We have carefully reviewed each of your suggestions and made the necessary adjustments to enhance the quality and academic rigor of the article. Below, we present our detailed responses to your observations. 1. Introduction and Use of Literature: We appreciate your suggestion to strengthen the theoretical foundation with global references. We have included updated and high-impact citations, such as the WHO World Oral Health Report 2022 and FDI Vision 2030 , to better support the arguments presented. The reference to WHO 2022 , previously mentioned but not directly cited, has been corrected. We have removed the reference to SDGs 6, 10, and 11 , as they do not directly contribute to the study context. Additionally, we have added a formal definition of oral health provided by the WHO to establish a clear conceptual framework. 2. Methodological Issues: We acknowledge the inappropriate use of causal terms such as "impact" and "influence" within the context of a correlational design. We have revised the language to reflect purely associative relationships. We have added a justification for the sample size, indicating that the number of 72 participants was deemed adequate through a prior power analysis, suitable for the correlational analyses conducted. 3. Instruments and Transparency: We appreciate the observation regarding the classification of OHIP-14 . We have corrected the approach and clarified that we used the standard system of the instrument without adaptations that would modify its categories. Regarding the reference to Cruzado et al. (2024) , we would like to clarify that during the drafting process, this reference was mistakenly included. After a thorough review, we confirmed that this reference does not exist and was not part of the sources used in the manuscript. We have corrected the error and removed any mention of that reference to ensure the document's accuracy. Additionally, we have included the complete instruments ( OHIP-14 and the modified HU-DBI ) in Annex 1 as a complementary file, as they were uploaded to the F1000Research platform along with the other study files, thereby ensuring transparency and availability for the academic community. 4. Statistical Reporting and Interpretation: We have added the corresponding confidence intervals (CIs) for the correlations and regressions presented to improve the precision of the results interpretation. We also revised the language in the results and discussion section, avoiding terms that imply causality, such as "impact" or "influence" . 5. Discussion and Conclusion: We adjusted the tone of the discussion to avoid generalizations that are not justified, considering the sample size and the specific context of the study. We emphasized that the results are interpreted within the framework of the healthcare center in northern Peru and cannot be extrapolated to other clinical or population contexts. Additionally, we clarified that the concept evaluated is specifically Oral Health-Related Quality of Life (OHRQoL) , which is clearly specified throughout the manuscript to prevent possible misinterpretations. 6. References: We have added the key references suggested, including the WHO World Oral Health Report 2022 and Vision 2030: Delivering Optimal Oral Health for All . Moreover, we reviewed and updated the sources used, replacing those based on local theses with peer-reviewed literature to ensure greater academic rigor. Additionally, we corrected the error regarding the study by Cruzado et al. (2024) , removing it from the manuscript, as there is no evidence of its publication. We once again appreciate your dedication to reviewing our manuscript. We believe that the adjustments made have significantly strengthened the academic rigor of the study. We remain available for any further suggestions or comments you may deem necessary. Sincerely, Miryam Griselda Lora Loza and co-authors. Competing Interests: No competing interests were disclosed Close Report a concern Author Response 02 May 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 02 May 2025 Author Response Dear Reviewer, We sincerely appreciate your thorough review and constructive feedback on our manuscript. Below we detail how each of your observations has been addressed in the revised version: ... Continue reading Dear Reviewer, We sincerely appreciate your thorough review and constructive feedback on our manuscript. Below we detail how each of your observations has been addressed in the revised version: Use of Literature and International Sources ➤ Action taken: We expanded the literature review by integrating key international sources, including the WHO World Oral Health Report 2022 , FDI Vision 2030 , UNESCO , and UNDP documents to provide a stronger global perspective on oral health policy and inequality. Definition of Oral Health ➤ Action taken: The WHO's formal definition of oral health has been incorporated in the Introduction to frame the central concept more precisely. Use of the term “correlational-causal” ➤ Action taken: The term was completely removed. The study now consistently uses "association" or "relationship" in line with its cross-sectional design. Sample Size Justification ➤ Action taken: We added a justification using G*Power software (effect size ρ = 0.30, α = 0.05, power = 0.80), which supports the adequacy of the sample size (n = 72). Availability of Full Instruments ➤ Action taken: The full versions of the OHIP-14 and HU-DBI questionnaires (Spanish versions), along with the expert validation matrix and reliability metrics, have been uploaded to Zenodo . Links: Dataset: https://doi.org/10.5281/zenodo.14847738 Methodological annex: https://doi.org/10.5281/zenodo.15236712 Overstatement and Global Generalization ➤ Action taken: We revised the Discussion and Conclusion to better acknowledge methodological limitations and avoid overgeneralizing findings beyond the local context. Clarification between General QoL and OHRQoL ➤ Action taken: The construct of Oral Health-Related Quality of Life (OHRQoL) has been explicitly defined and distinguished from general quality of life (QoL), reinforcing its role as the dependent variable. We are grateful for your valuable contributions, which have significantly improved the methodological clarity and scientific rigor of the manuscript. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) Dear Reviewer, We sincerely appreciate your thorough review and constructive feedback on our manuscript. Below we detail how each of your observations has been addressed in the revised version: Use of Literature and International Sources ➤ Action taken: We expanded the literature review by integrating key international sources, including the WHO World Oral Health Report 2022 , FDI Vision 2030 , UNESCO , and UNDP documents to provide a stronger global perspective on oral health policy and inequality. Definition of Oral Health ➤ Action taken: The WHO's formal definition of oral health has been incorporated in the Introduction to frame the central concept more precisely. Use of the term “correlational-causal” ➤ Action taken: The term was completely removed. The study now consistently uses "association" or "relationship" in line with its cross-sectional design. Sample Size Justification ➤ Action taken: We added a justification using G*Power software (effect size ρ = 0.30, α = 0.05, power = 0.80), which supports the adequacy of the sample size (n = 72). Availability of Full Instruments ➤ Action taken: The full versions of the OHIP-14 and HU-DBI questionnaires (Spanish versions), along with the expert validation matrix and reliability metrics, have been uploaded to Zenodo . Links: Dataset: https://doi.org/10.5281/zenodo.14847738 Methodological annex: https://doi.org/10.5281/zenodo.15236712 Overstatement and Global Generalization ➤ Action taken: We revised the Discussion and Conclusion to better acknowledge methodological limitations and avoid overgeneralizing findings beyond the local context. Clarification between General QoL and OHRQoL ➤ Action taken: The construct of Oral Health-Related Quality of Life (OHRQoL) has been explicitly defined and distinguished from general quality of life (QoL), reinforcing its role as the dependent variable. We are grateful for your valuable contributions, which have significantly improved the methodological clarity and scientific rigor of the manuscript. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 07 May 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 07 May 2025 Author Response Dear Reviewer, Faris Yahya I. Asiri King Faisal University, Saudi Arabia We are sincerely grateful for your thorough review and constructive recommendations. Your observations have significantly contributed to the scientific ... Continue reading Dear Reviewer, Faris Yahya I. Asiri King Faisal University, Saudi Arabia We are sincerely grateful for your thorough review and constructive recommendations. Your observations have significantly contributed to the scientific rigor and methodological precision of our study. Below, we detail our responses to each point raised: Use of Literature and International Sources ➤ Action taken: We expanded the literature review by integrating key international references, including the WHO World Oral Health Report 2022 , FDI Vision 2030 , UNESCO , and UNDP . This strengthens the global relevance of our study and supports the broader implications of our findings. Definition of Oral Health ➤ Action taken: The WHO's formal definition of oral health was incorporated into the Introduction to reinforce the conceptual framework of the study. Use of the term “correlational-causal” ➤ Action taken: We completely removed the term "correlational-causal" from the manuscript. Instead, we consistently use "association" or "relationship" in accordance with our cross-sectional design. Sample Size Justification ➤ Action taken: We added a sample size justification using GPower software (effect size ρ = 0.30, α = 0.05, power = 80%), supporting the adequacy of the chosen sample (n = 72). Availability of Full Instruments ➤ Action taken: The complete versions of the OHIP-14 and HU-DBI (Spanish version) were uploaded to Zenodo, along with their validation matrices and reliability reports. Dataset: https://doi.org/10.5281/zenodo.14847738 Methodological Annex: https://doi.org/10.5281/zenodo.15236712 Overstatement and Global Generalization ➤ Action taken: We revised the Discussion and Conclusion sections to avoid overgeneralizing results. We emphasized the local scope and acknowledged methodological limitations. Clarification between General QoL and OHRQoL ➤ Action taken: We explicitly distinguished Oral Health-Related Quality of Life (OHRQoL) from general Quality of Life (QoL), clarifying its role as the dependent variable in our analysis. Title Modification ➤ Action taken: In response to your and Reviewer 1’s suggestions, the original title “Impact of oral health perception on quality of life” was revised to: “Relationship between the perception of oral health and the quality of life of hospital staff” , in order to better reflect the non-causal, correlational nature of the study. We trust these revisions meet your expectations and contribute to the improved quality and clarity of the manuscript. Once again, we thank you for your valuable insights and support. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) Dear Reviewer, Faris Yahya I. Asiri King Faisal University, Saudi Arabia We are sincerely grateful for your thorough review and constructive recommendations. Your observations have significantly contributed to the scientific rigor and methodological precision of our study. Below, we detail our responses to each point raised: Use of Literature and International Sources ➤ Action taken: We expanded the literature review by integrating key international references, including the WHO World Oral Health Report 2022 , FDI Vision 2030 , UNESCO , and UNDP . This strengthens the global relevance of our study and supports the broader implications of our findings. Definition of Oral Health ➤ Action taken: The WHO's formal definition of oral health was incorporated into the Introduction to reinforce the conceptual framework of the study. Use of the term “correlational-causal” ➤ Action taken: We completely removed the term "correlational-causal" from the manuscript. Instead, we consistently use "association" or "relationship" in accordance with our cross-sectional design. Sample Size Justification ➤ Action taken: We added a sample size justification using GPower software (effect size ρ = 0.30, α = 0.05, power = 80%), supporting the adequacy of the chosen sample (n = 72). Availability of Full Instruments ➤ Action taken: The complete versions of the OHIP-14 and HU-DBI (Spanish version) were uploaded to Zenodo, along with their validation matrices and reliability reports. Dataset: https://doi.org/10.5281/zenodo.14847738 Methodological Annex: https://doi.org/10.5281/zenodo.15236712 Overstatement and Global Generalization ➤ Action taken: We revised the Discussion and Conclusion sections to avoid overgeneralizing results. We emphasized the local scope and acknowledged methodological limitations. Clarification between General QoL and OHRQoL ➤ Action taken: We explicitly distinguished Oral Health-Related Quality of Life (OHRQoL) from general Quality of Life (QoL), clarifying its role as the dependent variable in our analysis. Title Modification ➤ Action taken: In response to your and Reviewer 1’s suggestions, the original title “Impact of oral health perception on quality of life” was revised to: “Relationship between the perception of oral health and the quality of life of hospital staff” , in order to better reflect the non-causal, correlational nature of the study. We trust these revisions meet your expectations and contribute to the improved quality and clarity of the manuscript. Once again, we thank you for your valuable insights and support. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 15 Jul 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 15 Jul 2025 Author Response Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely thank ... Continue reading Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely thank Reviewer 1, Dr. Faris Yahya I. Asiri, for his constructive and thoughtful observations. Below, we provide detailed responses to each of his comments, along with the specific sections where changes were made in the revised manuscript. All edits are clearly marked in the tracked version. 1. Study objectives and rationale – Clarify the purpose and design Comment: The objective of the study and the rationale need to be more clearly presented in the introduction and methods. Response: We appreciate this valuable observation. The objective was reformulated to explicitly state that the study aims to examine the association between oral health perception and oral health-related quality of life (OHRQoL) among hospital staff. We also clarified the study design as correlational and cross-sectional in both the Introduction and the Methods sections. Changes made in: Introduction (last paragraph), Methods – Design subsection. 2. Sampling method and population – Explain selection criteria Comment: Please provide more details about the population selection and inclusion/exclusion criteria. Response: We added detailed information about the inclusion and exclusion criteria and specified that the sample was selected by non-probabilistic convenience sampling from staff working at a level II hospital in northern Peru. The rationale for this selection was also explained. Changes made in: Methods – Population and Sampling section. 3. Instruments – Provide psychometric information Comment: More information is needed on the validity and reliability of the instruments used. Response: We provided complete psychometric information for both the OHIP-14 and HU-DBI instruments. The OHIP-14 has been widely validated in Spanish-speaking populations. For the HU-DBI, we clarified that its Spanish version was adapted through expert judgment for content validity, and internal consistency was calculated using Cronbach’s alpha. All related evidence and matrices are now available in Appendix 1 and open-access via Zenodo. Changes made in: Methods – Instruments subsection; Supplementary Appendix 1; References (Zenodo DOI: https://doi.org/10.5281/zenodo.15236712 ). 4. Statistical analysis – More clarity needed Comment: Clarify how the variables were analyzed and justify the tests used. Response: We improved the description of the statistical analysis. We explained the use of Spearman’s correlation due to non-normal data distribution, and logistic regression to explore the association between OHP and OHRQoL domains. Confidence intervals (95%) were added to support the strength and precision of the results. Changes made in: Methods – Data Analysis subsection; Results – Table 3 and text. 5. Interpretation of findings – Avoid causal language Comment: The interpretation of findings should not suggest causality in a cross-sectional design. Response: We revised the Discussion and Conclusion sections to avoid any causal implications, consistently using associative and correlational terminology. We acknowledge the limitations of cross-sectional studies and emphasized the need for further longitudinal research. Changes made in: Discussion and Conclusion sections. 6. Ethical considerations – Add details on approvals Comment: Please confirm ethical approval and participant consent. Response: We added that the study received ethical approval from the Institutional Ethics Committee of Universidad César Vallejo (Approval No. 007-2025-CEI), and that written informed consent was obtained from all participants in accordance with the Declaration of Helsinki. Changes made in: Methods – Ethical Considerations subsection. We thank Reviewer 1 for his invaluable contributions. His remarks allowed us to strengthen the scientific robustness, ethical transparency, and methodological consistency of our study. Respectfully, Dr. Miryam Griselda Lora Loza On behalf of all co-authors Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely thank Reviewer 1, Dr. Faris Yahya I. Asiri, for his constructive and thoughtful observations. Below, we provide detailed responses to each of his comments, along with the specific sections where changes were made in the revised manuscript. All edits are clearly marked in the tracked version. 1. Study objectives and rationale – Clarify the purpose and design Comment: The objective of the study and the rationale need to be more clearly presented in the introduction and methods. Response: We appreciate this valuable observation. The objective was reformulated to explicitly state that the study aims to examine the association between oral health perception and oral health-related quality of life (OHRQoL) among hospital staff. We also clarified the study design as correlational and cross-sectional in both the Introduction and the Methods sections. Changes made in: Introduction (last paragraph), Methods – Design subsection. 2. Sampling method and population – Explain selection criteria Comment: Please provide more details about the population selection and inclusion/exclusion criteria. Response: We added detailed information about the inclusion and exclusion criteria and specified that the sample was selected by non-probabilistic convenience sampling from staff working at a level II hospital in northern Peru. The rationale for this selection was also explained. Changes made in: Methods – Population and Sampling section. 3. Instruments – Provide psychometric information Comment: More information is needed on the validity and reliability of the instruments used. Response: We provided complete psychometric information for both the OHIP-14 and HU-DBI instruments. The OHIP-14 has been widely validated in Spanish-speaking populations. For the HU-DBI, we clarified that its Spanish version was adapted through expert judgment for content validity, and internal consistency was calculated using Cronbach’s alpha. All related evidence and matrices are now available in Appendix 1 and open-access via Zenodo. Changes made in: Methods – Instruments subsection; Supplementary Appendix 1; References (Zenodo DOI: https://doi.org/10.5281/zenodo.15236712 ). 4. Statistical analysis – More clarity needed Comment: Clarify how the variables were analyzed and justify the tests used. Response: We improved the description of the statistical analysis. We explained the use of Spearman’s correlation due to non-normal data distribution, and logistic regression to explore the association between OHP and OHRQoL domains. Confidence intervals (95%) were added to support the strength and precision of the results. Changes made in: Methods – Data Analysis subsection; Results – Table 3 and text. 5. Interpretation of findings – Avoid causal language Comment: The interpretation of findings should not suggest causality in a cross-sectional design. Response: We revised the Discussion and Conclusion sections to avoid any causal implications, consistently using associative and correlational terminology. We acknowledge the limitations of cross-sectional studies and emphasized the need for further longitudinal research. Changes made in: Discussion and Conclusion sections. 6. Ethical considerations – Add details on approvals Comment: Please confirm ethical approval and participant consent. Response: We added that the study received ethical approval from the Institutional Ethics Committee of Universidad César Vallejo (Approval No. 007-2025-CEI), and that written informed consent was obtained from all participants in accordance with the Declaration of Helsinki. Changes made in: Methods – Ethical Considerations subsection. We thank Reviewer 1 for his invaluable contributions. His remarks allowed us to strengthen the scientific robustness, ethical transparency, and methodological consistency of our study. Respectfully, Dr. Miryam Griselda Lora Loza On behalf of all co-authors Competing Interests: The authors declare that there are no competing interests. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: John MT. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.177142.r371448 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v1#referee-response-371448 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 Mar 2025 Mike T John , University of Minnesota, Minneapolis, USA Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.177142.r371448 The manuscript “Impact of oral health perception on the quality of life of hospital staff” aimed to “analyze the relationship between the QoL and the PSB of the staff of a level II-1 hospital, located in the north of Peru, ... Continue reading READ ALL The manuscript “Impact of oral health perception on the quality of life of hospital staff” aimed to “analyze the relationship between the QoL and the PSB of the staff of a level II-1 hospital, located in the north of Peru, taking into account its dimensions and interactions. The research aims to provide evidence to design strategies that promote the well-being of health personnel and optimize the quality of care provided to patients.” The topic is interesting and relevant, but the methodology is flawed. The researchers are interested to “provide evidence to design strategies that promote the well-being of health personnel and optimize the quality of care provided to patients.” However, the authors performed a cross-sectional study, and this study design is not able to derive “evidence” for “promotion strategies.” Such evidence can only be derived from longitudinal studies. Is the work clearly and accurately presented and does it cite the current literature? – No The authors are not aware that OHRQoL measured by OHIP does not have 7 dimensions. OHRQoL has four dimensions (John MT, 2020 [Ref-1]). The authors are not aware of the recent scoring recommendations for OHIP (John MT., 2022 [Ref-2]). Is the study design appropriate and is the work technically sound? – No The authors performed a cross-sectional study when a longitudinal study would have been necessary to answer the research question. Are sufficient details of methods and analysis provided to allow replication by others? – No The central study outcome is oral health-related quality of life measured by OHIP-14. The authors provided the following information: “Regarding the instruments, the Quality of Life (QoL) Questionnaire was used, originally designed by Slade and Spencer in 1994, adapted by Espinoza in 2017, and updated and validated in 2024 by Cruzado, Alvarado, and Lora. Loza. This questionnaire includes 14 items organized into 7 dimensions (Functional limitation, Physical pain, Psychological discomfort, Physical disabilities, Psychological disabilities, Social disability, and Disability), with 2 items per dimension. A 5-point Likert scale was applied (0 = never, 4 = very frequently), the results of which were classified into three categories: excellent (0-2 points), average (3-9 points), and poor quality of life (10 points or more).” The authors provided in the reference list a reference to Slade and Spencer and to Espinoza; however, a reference to “updated and validated in 2024 by Cruzado, Alvarado, and Lora. Loza” is missing. Therefore, it is not clear what was measured, especially, because the authors use an item response scale ranging from “never” to “very frequently,” which is not OHIP’s original response format. If applicable, is the statistical analysis and its interpretation appropriate? – No For many results, e.g., “significant association between quality of life and oral health perception (Rho=0.391, p<0.05)”, the authors only provided point estimates. Confidence intervals around point estimates describe the uncertainty around the results. In this study with N=72, this uncertainty is substantial. Calculating a confidence interval according to https://www.statskingdom.com/correlation-confidence-interval-calculator.html reveals that correlations as small as 0.18 and as large as 0.57 are compatible with the study. While the observed correlation of 0.391 is statistically significant, i.e., it can be differentiated from 0, the observed “medium” size correlation could be “small” or “large” when the study would be repeated, indicating that not much can be learned from the study. Are the conclusions drawn adequately supported by the results? – No The authors concluded “The link between quality of life and the perception of oral health in hospital staff emphasizes the need to implement comprehensive strategies that optimize their well-being and work performance, contributing significantly to improving hospital services.” First, the authors make a statement about quality of life. However, quality of life (a construct that entails environment, safety, freedom etc.) was not measured. ORAL HEALTH-RELATED quality of life was measured. Second, the magnitude of the link between oral health-related quality of life and perception of oral health is not clear. It could be small, i.e., not clinically relevant. Third, “the need to implement comprehensive strategies” is not supported by the cross-sectional study design. Is the work clearly and accurately presented and does it cite the current literature? No Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? No References 1. John MT: Foundations of oral health-related quality of life. J Oral Rehabil . 2020. PubMed Abstract | Publisher Full Text 2. John MT: STANDARDIZATION OF DENTAL PATIENT-REPORTED OUTCOMES MEASUREMENT USING OHIP-5 - VALIDATION OF "RECOMMENDATIONS FOR USE AND SCORING OF ORAL HEALTH IMPACT PROFILE VERSIONS". J Evid Based Dent Pract . 2022; 22 (1S): 101645 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: oral health-related quality of life I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT John MT. Reviewer Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.177142.r371448 ) The direct URL for this report is: https://f1000research.com/articles/14-238/v1#referee-response-371448 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 02 Jun 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 02 Jun 2025 Author Response Dear Dr. Mike T. John, Warm greetings. I wish to express my deepest gratitude for the time and expertise you invested in reviewing our manuscript. Your thorough and ... Continue reading Dear Dr. Mike T. John, Warm greetings. I wish to express my deepest gratitude for the time and expertise you invested in reviewing our manuscript. Your thorough and constructive feedback has been instrumental in guiding substantial improvements to our study entitled: “Relationship between oral health perception and quality of life in hospital staff.” I humbly apologize for not responding sooner to your detailed review. At the time, I was not yet familiar with the F1000Research platform and unfortunately overlooked your comments. Now that I have a better understanding of the system, I wish to respectfully inform you that all your major observations have now been addressed in the revised version, including: Title and Causal Language : The word “impact” was replaced with “relationship” , and causal or prescriptive expressions were carefully revised to remain within the scope of a correlational, cross-sectional design. Clarification of OHIP-14 Scoring : We corrected the dimensional interpretation and cited John (2020, 2022) for standard scoring guidance. The questionnaire was reformulated to respect international standards and now includes proper acknowledgment of the four-dimensional structure of OHRQoL. Psychometric Validity : We uploaded the full instruments (OHIP-14 and HU-DBI) including psychometric data to Zenodo , ensuring full transparency and replicability. Statistical Reporting : We added confidence intervals for correlation coefficients and justified the sample size using G*Power , as well as reporting Nagelkerke’s pseudo R² to better interpret the logistic regression outcomes. Terminology : We replaced the term “quality of life” with “oral health-related quality of life” throughout the manuscript to maintain conceptual accuracy. Conclusions Revised : We rephrased our conclusions to reflect the statistical scope and limitations of a cross-sectional study, without suggesting implementation of strategies not directly derived from the design. These modifications were made not only out of respect for your review, but also in appreciation for your high standards in the field of oral health-related quality of life research. We believe that the manuscript now meets the criteria for methodological and scientific integrity and would be deeply honored if you could consider revisiting the updated version. Please feel free to share any further suggestions—we remain open and grateful to continue improving. With highest respect and appreciation, Miryam Griselda Lora Loza Corresponding Author Dear Dr. Mike T. John, Warm greetings. I wish to express my deepest gratitude for the time and expertise you invested in reviewing our manuscript. Your thorough and constructive feedback has been instrumental in guiding substantial improvements to our study entitled: “Relationship between oral health perception and quality of life in hospital staff.” I humbly apologize for not responding sooner to your detailed review. At the time, I was not yet familiar with the F1000Research platform and unfortunately overlooked your comments. Now that I have a better understanding of the system, I wish to respectfully inform you that all your major observations have now been addressed in the revised version, including: Title and Causal Language : The word “impact” was replaced with “relationship” , and causal or prescriptive expressions were carefully revised to remain within the scope of a correlational, cross-sectional design. Clarification of OHIP-14 Scoring : We corrected the dimensional interpretation and cited John (2020, 2022) for standard scoring guidance. The questionnaire was reformulated to respect international standards and now includes proper acknowledgment of the four-dimensional structure of OHRQoL. Psychometric Validity : We uploaded the full instruments (OHIP-14 and HU-DBI) including psychometric data to Zenodo , ensuring full transparency and replicability. Statistical Reporting : We added confidence intervals for correlation coefficients and justified the sample size using G*Power , as well as reporting Nagelkerke’s pseudo R² to better interpret the logistic regression outcomes. Terminology : We replaced the term “quality of life” with “oral health-related quality of life” throughout the manuscript to maintain conceptual accuracy. Conclusions Revised : We rephrased our conclusions to reflect the statistical scope and limitations of a cross-sectional study, without suggesting implementation of strategies not directly derived from the design. These modifications were made not only out of respect for your review, but also in appreciation for your high standards in the field of oral health-related quality of life research. We believe that the manuscript now meets the criteria for methodological and scientific integrity and would be deeply honored if you could consider revisiting the updated version. Please feel free to share any further suggestions—we remain open and grateful to continue improving. With highest respect and appreciation, Miryam Griselda Lora Loza Corresponding Author Competing Interests: None declared. Close Report a concern Author Response 25 Nov 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 25 Nov 2025 Author Response Dear Dr. John, as a brief update: Version 5 integrates your core recommendations—OHIP conceptualization (four dimensions) and scoring aligned with John (2020; 2022), non-causal language for a cross-sectional design, 95% ... Continue reading Dear Dr. John, as a brief update: Version 5 integrates your core recommendations—OHIP conceptualization (four dimensions) and scoring aligned with John (2020; 2022), non-causal language for a cross-sectional design, 95% CIs added to correlations, and instruments/data shared openly. We appreciate your foundational input and would be grateful for any further advice. All changes are visible in V5 (tracked). Dear Dr. John, as a brief update: Version 5 integrates your core recommendations—OHIP conceptualization (four dimensions) and scoring aligned with John (2020; 2022), non-causal language for a cross-sectional design, 95% CIs added to correlations, and instruments/data shared openly. We appreciate your foundational input and would be grateful for any further advice. All changes are visible in V5 (tracked). Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 02 Jun 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 02 Jun 2025 Author Response Dear Dr. Mike T. John, Warm greetings. I wish to express my deepest gratitude for the time and expertise you invested in reviewing our manuscript. Your thorough and ... Continue reading Dear Dr. Mike T. John, Warm greetings. I wish to express my deepest gratitude for the time and expertise you invested in reviewing our manuscript. Your thorough and constructive feedback has been instrumental in guiding substantial improvements to our study entitled: “Relationship between oral health perception and quality of life in hospital staff.” I humbly apologize for not responding sooner to your detailed review. At the time, I was not yet familiar with the F1000Research platform and unfortunately overlooked your comments. Now that I have a better understanding of the system, I wish to respectfully inform you that all your major observations have now been addressed in the revised version, including: Title and Causal Language : The word “impact” was replaced with “relationship” , and causal or prescriptive expressions were carefully revised to remain within the scope of a correlational, cross-sectional design. Clarification of OHIP-14 Scoring : We corrected the dimensional interpretation and cited John (2020, 2022) for standard scoring guidance. The questionnaire was reformulated to respect international standards and now includes proper acknowledgment of the four-dimensional structure of OHRQoL. Psychometric Validity : We uploaded the full instruments (OHIP-14 and HU-DBI) including psychometric data to Zenodo , ensuring full transparency and replicability. Statistical Reporting : We added confidence intervals for correlation coefficients and justified the sample size using G*Power , as well as reporting Nagelkerke’s pseudo R² to better interpret the logistic regression outcomes. Terminology : We replaced the term “quality of life” with “oral health-related quality of life” throughout the manuscript to maintain conceptual accuracy. Conclusions Revised : We rephrased our conclusions to reflect the statistical scope and limitations of a cross-sectional study, without suggesting implementation of strategies not directly derived from the design. These modifications were made not only out of respect for your review, but also in appreciation for your high standards in the field of oral health-related quality of life research. We believe that the manuscript now meets the criteria for methodological and scientific integrity and would be deeply honored if you could consider revisiting the updated version. Please feel free to share any further suggestions—we remain open and grateful to continue improving. With highest respect and appreciation, Miryam Griselda Lora Loza Corresponding Author Dear Dr. Mike T. John, Warm greetings. I wish to express my deepest gratitude for the time and expertise you invested in reviewing our manuscript. Your thorough and constructive feedback has been instrumental in guiding substantial improvements to our study entitled: “Relationship between oral health perception and quality of life in hospital staff.” I humbly apologize for not responding sooner to your detailed review. At the time, I was not yet familiar with the F1000Research platform and unfortunately overlooked your comments. Now that I have a better understanding of the system, I wish to respectfully inform you that all your major observations have now been addressed in the revised version, including: Title and Causal Language : The word “impact” was replaced with “relationship” , and causal or prescriptive expressions were carefully revised to remain within the scope of a correlational, cross-sectional design. Clarification of OHIP-14 Scoring : We corrected the dimensional interpretation and cited John (2020, 2022) for standard scoring guidance. The questionnaire was reformulated to respect international standards and now includes proper acknowledgment of the four-dimensional structure of OHRQoL. Psychometric Validity : We uploaded the full instruments (OHIP-14 and HU-DBI) including psychometric data to Zenodo , ensuring full transparency and replicability. Statistical Reporting : We added confidence intervals for correlation coefficients and justified the sample size using G*Power , as well as reporting Nagelkerke’s pseudo R² to better interpret the logistic regression outcomes. Terminology : We replaced the term “quality of life” with “oral health-related quality of life” throughout the manuscript to maintain conceptual accuracy. Conclusions Revised : We rephrased our conclusions to reflect the statistical scope and limitations of a cross-sectional study, without suggesting implementation of strategies not directly derived from the design. These modifications were made not only out of respect for your review, but also in appreciation for your high standards in the field of oral health-related quality of life research. We believe that the manuscript now meets the criteria for methodological and scientific integrity and would be deeply honored if you could consider revisiting the updated version. Please feel free to share any further suggestions—we remain open and grateful to continue improving. With highest respect and appreciation, Miryam Griselda Lora Loza Corresponding Author Competing Interests: None declared. Close Report a concern Author Response 25 Nov 2025 [email protected] Lora Loza , Graduate School, César Vallejo University, Trujillo, 13001, Peru 25 Nov 2025 Author Response Dear Dr. John, as a brief update: Version 5 integrates your core recommendations—OHIP conceptualization (four dimensions) and scoring aligned with John (2020; 2022), non-causal language for a cross-sectional design, 95% ... Continue reading Dear Dr. John, as a brief update: Version 5 integrates your core recommendations—OHIP conceptualization (four dimensions) and scoring aligned with John (2020; 2022), non-causal language for a cross-sectional design, 95% CIs added to correlations, and instruments/data shared openly. We appreciate your foundational input and would be grateful for any further advice. All changes are visible in V5 (tracked). Dear Dr. John, as a brief update: Version 5 integrates your core recommendations—OHIP conceptualization (four dimensions) and scoring aligned with John (2020; 2022), non-causal language for a cross-sectional design, 95% CIs added to correlations, and instruments/data shared openly. We appreciate your foundational input and would be grateful for any further advice. All changes are visible in V5 (tracked). Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 6 VERSION 6 PUBLISHED 26 Feb 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 5 6 Version 6 (revision) 28 Jan 26 read Version 5 (revision) 10 Dec 25 read read read Version 4 (revision) 13 Oct 25 read read read Version 3 (revision) 16 Jun 25 read Version 2 (revision) 02 May 25 read Version 1 26 Feb 25 read read read Mike T John , University of Minnesota, Minneapolis, USA Faris Yahya I Asiri , King Faisal University, Al-Ahsa, Saudi Arabia Haslinda Ramli , University Sains Islam Malaysia, Kuala Lumpur, Malaysia Fadil Abdillah Arifin , Universitas Muslim Indonesia, Makassar, Indonesia Nur Surya Wirawan , Universitas Hasanuddin Fakultas Kedokteran (Ringgold ID: 355661), Makassar, Indonesia Pankaj Dhawan , Manav Rachna International Institute of Research and Studies, Faridabad, India Rasha Salah , University of Baghdad, Baghdad, Iraq Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Arifin F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 Mar 2026 | for Version 6 Fadil Abdillah Arifin , Universitas Muslim Indonesia, Makassar, Indonesia 0 Views copyright © 2026 Arifin F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I have checked the PPT file of the flowchart that was made according to the previous instructions. The flowchart is quite good and well-structured. Thank you. Competing Interests No competing interests were disclosed. Reviewer Expertise OHRQoL, Medical and dental education, Endodontics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Arifin FA. Peer Review Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.195409.r453581) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-238/v6#referee-response-453581 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Arifin F et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 30 Dec 2025 | for Version 5 Fadil Abdillah Arifin , Universitas Muslim Indonesia, Makassar, Indonesia Nur Surya Wirawan , Department Anaesthesiology and Intensive Therapy, Universitas Hasanuddin Fakultas Kedokteran (Ringgold ID: 355661), Makassar, South Sulawesi, Indonesia 0 Views copyright © 2026 Arifin F et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1. OK 2. OK 3. I have not yet viewed the flowchart as I previously recommended. A flowchart is essential for readers to understand the research process and facilitate the replication of analogous research methodologies. The author has already provided clarification; however, the flowchart I am referencing is a research flowchart in image format. 4. OK 5. OK 6. OK Competing Interests No competing interests were disclosed. Reviewer Expertise OHRQoL, Medical and dental education, Endodontics We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 28 Jan 2026 [email protected] Lora Loza, Graduate School, César Vallejo University, Lima, 15311, Peru The requested research methodology flowchart has now been provided in image format and uploaded as a separate figure file ( Figure 2: Research methodology flowchart / methodological framework ). In addition, the Methods section explicitly cites Figure 2 to guide readers through the study workflow (study design and setting, population and sampling, instruments, procedure, and statistical analyses). The authors believe this addition improves transparency and facilitates replication of analogous research methodologies. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Arifin FA and Wirawan NS. Peer Review Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.191197.r440649) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-238/v5#referee-response-440649 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Dhawan P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Dec 2025 | for Version 5 Pankaj Dhawan , SCHOOL OF DENTAL SCIENCES, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India 0 Views copyright © 2026 Dhawan P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The study is a competently executed cross-sectional analysis that makes a valuable contribution to the regional literature on occupational oral health. The authors successfully document a significant association between a staff member's subjective assessment of their oral health (Perceived Oral Health, POH) and their overall oral-health-related quality of life (OHRQOL). This study provides compelling evidence of the link between self-perceived oral health and well-being among hospital staff, strongly supporting the need for targeted, context-specific workplace oral health promotion strategies. While the methodological limitations prevent broad generalization and causal claims, the authors have shown an excellent ability to respond to scientific peer review, leading to a much stronger and more transparent Version 5. The core finding regarding the knowledge gap is a clear mandate for immediate public health action in this setting. https://f1000research.com/articles/14-238/v4#referee-response-428725 Competing Interests No competing interests were disclosed. Reviewer Expertise Education, Dentistry, Research, Oral health. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 02 Jan 2026 [email protected] Lora Loza, Graduate School, César Vallejo University, Lima, 15311, Peru Thank you for reviewing Version 5 and for approving the manuscript. We appreciate your confirmation that our revisions addressed the previous comments. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Dhawan P. Peer Review Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.191197.r440648) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-238/v5#referee-response-440648 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Salah R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Dec 2025 | for Version 5 Rasha Salah , University of Baghdad, Baghdad, Iraq 0 Views copyright © 2026 Salah R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions the authors have addressed my previous comments and revised the manuscript. Competing Interests No competing interests were disclosed. Reviewer Expertise periodontics, implantology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 02 Jan 2026 [email protected] Lora Loza, Graduate School, César Vallejo University, Lima, 15311, Peru Thank you for reviewing Version 5 and for confirming that the manuscript revisions adequately addressed all prior comments. We appreciate your approval. View more View less Competing Interests . reply Respond Report a concern Salah R. Peer Review Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.191197.r440644) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-238/v5#referee-response-440644 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Salah R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 21 Nov 2025 | for Version 4 Rasha Salah , University of Baghdad, Baghdad, Iraq 0 Views copyright © 2025 Salah R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions there are missing detais in the methodology: • Who administered the questionnaires? • Were they self-administered or interviewer-administered? • What was the response rate (72 out of 80 = 90%)? • Were there systematic differences between participants and non-participants? • What time period for data collection? • Any quality control measures during data collection? statistcs Despite technically correct methods, the interpretation of results is questionable: Overstating the Strength of Association A correlation of 0.391 may be statistically significant but is of questionable clinical importance. The authors never addressed: • What magnitude of correlation would be clinically meaningful? • Does a ρ = 0.391 justify implementing oral health interventions? • What is the minimal clinically important difference for OHRQoL? • Who administered the questionnaires? • Were they self-administered or interviewer-administered? • What was the response rate (72 out of 80 = 90%)? • Were there systematic differences between participants and non-participants? • What time period for data collection? • Any quality control measures during data collection? The authors acknowledge limitations but don’t provide: • Comparison of their sample characteristics to the broader hospital staff population • Discussion of how their hospital compares to other Level II-1 hospitals in Peru • Any external validation or comparison with other studies in similar settings The authors don’t adequately compare their findings to existing research: • Is ρ = 0.391 consistent with other studies? • Is this stronger or weaker than expected? • What correlations have other researchers found between POH and OHRQoL? Without this context, readers cannot judge whether the finding is novel, confirmatory, or surprisingly weak. The conclusions significantly overreach beyond what the data support. The authors: 1. Imply causality from correlational data 2. Recommend interventions without testing them 3. Generalize from a single-site convenience sample 4. Don’t adequately acknowledge the 80% unexplained variance 5. Don’t establish clinical significance of the modest correlation Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise periodontics, implantology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 02 Jan 2026 [email protected] Lora Loza, Graduate School, César Vallejo University, Lima, 15311, Peru Dear Dr. Salah, Thank you for your careful review and for highlighting specific areas where greater methodological transparency and interpretative balance were needed. We have revised the manuscript comprehensively to address each of your concerns. (1) Missing methodological details We expanded the Methods section to clearly specify: Administration : the questionnaires were distributed and collected by trained members of the research team, while responses were completed by participants. Mode : both instruments were self-administered . Response rate : we explicitly report 72/80 (90%) . Data collection period : we now state that data were collected between September and October 2024 . Quality control : we added the quality assurance steps implemented during fieldwork and prior to analysis (on-site completeness checks and verification of data entry). Participants vs non-participants : we clarified that demographic data from non-participants were not collected , therefore systematic comparisons could not be performed; this is now explicitly acknowledged as a limitation. (2) Strength of association and clinical relevance (ρ = 0.391) (ρ = 0.391; 95% CI 0.18–0.57) We agree that statistical significance does not equate to clinical importance. We revised the Discussion and Conclusions to frame the correlation ( ρ = 0.391 ) as modest in magnitude and to avoid overstatement. We now explicitly state that these findings are associative and do not justify intervention recommendations on their own. Regarding the minimal clinically important difference (MCID) , we clarified that MCID is typically defined for longitudinal or interventional change scores, and it is not directly applicable to a cross-sectional correlational estimate. (3) Contextualization with existing research We strengthened the Discussion by adding clearer comparisons with relevant studies assessing perceived oral health and OHRQoL, so that readers can judge whether the observed association is consistent with prior evidence and whether it is confirmatory or context-specific. (4) External validity and setting comparability In the Limitations section, we expanded our discussion of generalizability, emphasizing the single-site design, convenience sampling, and the lack of benchmarking against broader staff populations and other Level II-1 hospitals. We also outlined how future multicenter studies with probabilistic sampling and clinical examinations would address these gaps. (5) Conclusions and scope of inference We revised the conclusion to remove any causal language, avoid generalization beyond the study context, acknowledge the substantial unexplained variability, and present the findings as hypothesis-generating evidence that supports the need for longitudinal and clinically triangulated research. We sincerely appreciate your recommendations, which have improved the manuscript’s transparency and interpretative rigor. Kind regards, Miryam Griselda Lora Loza On behalf of all authors View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Salah R. Peer Review Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.188626.r428728) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-238/v4#referee-response-428728 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Dhawan P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 11 Nov 2025 | for Version 4 Pankaj Dhawan , SCHOOL OF DENTAL SCIENCES, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India 0 Views copyright © 2025 Dhawan P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1. Inability to Determine Causation is the single biggest gap. The cross-sectional design can only show that a relationship exists, not why . 2. The study's findings cannot be generalized to a wider population. This is due to two key design choices: "Non-probabilistic intentional convenience sampling" is a weak sampling method. It is not random and is prone to selection bias. The sample is small (n=72) and from a single institution . The staff at this one hospital may not be representative of all hospital staff in Peru, let alone globally. 3. The study relies 100% on self-reported questionnaires (POH and OHRQoL). There is no objective clinical data . The study cannot determine if the participants' perception of "poor" oral health matches their actual clinical status (e.g., a dental exam to count carious lesions, check for periodontal disease, etc.) 4. To address the gap in causation, a longitudinal study is needed. This would involve measuring POH at the start of the study (Time 1) and then measuring OHRQoL at a later date (Time 2). This could help establish a temporal (and potentially causal) link. 5. Objective clinical examinations by a calibrated dentist to measure actual disease status (e.g., DMFT index, periodontal charting). This would allow researchers to answer a much more interesting question: How well does perceived oral health align with actual clinical oral health? 6. To enhance generalizability, a future study must use a multi-center, randomized sampling strategy, recruiting a much larger number of participants from multiple hospitals (both public and private) across different regions. Mention and discuss in the Limitations and Future Research Section. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Education, Dentistry, Research, Oral health. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 10 Dec 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Lima, 15311, Peru Dear Dr. Dhawan, thank you for underscoring design and generalizability. Version 5 now makes explicit in Limitations and Future Research : (i) the cross-sectional design cannot establish causation; (ii) single-center, convenience sampling and the small n limit external validity; (iii) reliance on self-report without objective clinical exams. We also outline next steps: (iv) multicenter probabilistic sampling; (v) longitudinal follow-up to establish temporal ordering; and (vi) calibrated clinical assessments (e.g., DMFT , periodontal charting). We appreciate your guidance; these clarifications are incorporated and visible in V5 (tracked). View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Dhawan P. Peer Review Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.188626.r428725) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-238/v4#referee-response-428725 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Arifin F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 07 Nov 2025 | for Version 4 Fadil Abdillah Arifin , Universitas Muslim Indonesia, Makassar, Indonesia 0 Views copyright © 2025 Arifin F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The research is interesting as it examines the correlation between oral health perception and the quality of life among healthcare workers. This topic remains infrequently addressed, since many individuals believe that hospital personnel are exempt from health issues, especially related to oral health. The manuscript is sufficiently solid and clear in certain sections, facilitating study for other writers employing similar methodologies. The manuscript explicitly defines the limitations of the investigation. However, we should consider revising and adding certain sections to enhance the research manuscripts. The Abstract section should not include the research objectives found in the Introduction section. The introduction should explain the reasons for the study undertaking. Furthermore, a separate section provides clarification of the research's objective. It is hoped that it will be taken into consideration. Thank you. The Introduction section addresses the limited importance of examining OHRQoL among health personnel. Although they are the primary subjects seeking solutions in this study. The author may reference findings from several studies conducted in different regions of Peru or other nations to substantiate the significance of addressing this issue and seeking solutions. A suitable transitional sentence to link the background of the work to the study objective is absent. It is hoped that it can be comprehended and taken into account. Thank you. It is strongly advised to include a research workflow represented as a concise chart in the Methods section. Starting with the recruitment of research participants and ending in data analysis. It is crucial to offer this information to facilitate readers' comprehension of the research process, hence facilitating the application of similar methodologies. It is hoped that it will be taken into consideration. Thank you. What is the author's rationale for employing sample size estimation utilizing G Power? Although other alternative approaches exist for sample calculation. Kindly provide clarification. Thank you. What is the author's rationale for employing the OHIP-14 questionnaire to assess OHRQoL? What factors should be considered when opting not to utilize alternative questionnaires such as GOHAI? Kindly elucidate the author's viewpoint. Thank you. Could the authors explain how Espinoza categorized the three types of outcomes derived from OHIP-14? All aforementioned comments were articulated to enhance the manuscript, thereby facilitating the advancement of science, particularly in dentistry. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise OHRQoL, Medical and dental education, Endodontics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 10 Dec 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Lima, 15311, Peru Dear Dr. Arifin, we appreciate your helpful suggestions. In Version 5 we: (i) trimmed the Abstract to report background/methods/results/conclusion without restating the objective; (ii) strengthened the Introduction with additional context and an explicit bridge to the aim; (iii) clarified the study flow in the Procedure subsection (recruitment → consent → self-administered survey → scoring → analysis); (iv) justified the a priori sample size with G*Power 3.1 for ρ = 0.30, α = 0.05, 1–β = 0.80; (v) explained the choice of OHIP-14 over GOHAI for broader construct coverage in a mixed-age workforce; and (vi) detailed Espinoza’s three-level categorization and how domain thresholds were derived. We hope these edits improve clarity and replicability. All changes are visible in Version 5 (tracked). View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Arifin FA. Peer Review Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.188626.r428727) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-238/v4#referee-response-428727 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Ramli H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 01 Sep 2025 | for Version 3 Haslinda Ramli , University Sains Islam Malaysia, Kuala Lumpur, Malaysia 0 Views copyright © 2025 Ramli H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (2) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have addressed my previous comments in the revised manuscript. However, further revisions are required to enhance the quality of the paper: 1. Introduction - The definitions of the abbreviations IED, UNESCO or UNDP should be spelled out in the text. - A proper citation should be included for the statement “Hence the definitive IED Vision 2030 Report and the Resolution (2021) on oral health, which emphasize that oral health should be part of Universal Health Coverage (UHC) systems and in line with the global agenda to combat non-communicable diseases (NCDs)”. 2. Methodology - Provide evidence of the ethical approval issued by the institutional ethics committee including the corresponding code or reference number. 3. Result - The two categories for OHRQoL (‘Fair’ and ‘Poor’) are labelled inconsistently in Tables 1, 2, and 4 as ‘Regular’ and ‘Bad’. Please standardize the terminology for consistency. - The columns in Table 2 appear misaligned and should be corrected. 4. Discussion - How is your study consistent with the findings of Espinoza et al. (2022), given that your study reported 38.9% excellent OHRQoL, whereas Espinoza et al. (2022) reported 66.8%? Please clarify. - Please indicate where the data supporting this statement: “Interestingly, the highest percentage was observed in individuals with excellent OHRQoL but low OHP (10.4%) ”. - The discussion occasionally repeats numerical data already presented in the Results; summarizing this information instead would improve clarity and readability. 5. Conclusion - The conclusion could better emphasize the practical significance of the findings, not just the statistical relationships. - Avoid repetition of detailed statistics. Competing Interests No competing interests were disclosed. Reviewer Expertise Periodontology, Oral Health-Related Quality of Life, Oral Health Research, Oral microbiology, Natural product I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (2) Author Response 13 Oct 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Dr. Haslinda Ramli, We sincerely thank you for your valuable and constructive comments on Version 3 of our manuscript. We have carefully revised the paper to address all the points you raised: Abbreviations (IED, UNESCO, UNDP) are now defined at first mention, and appropriate citations have been added to the FDI Vision 2030 Report and the World Health Assembly Resolution on Oral Health (2021) . Ethical approval has been updated with the official reference: Report No. 00298-2024/CEI-PMGSS, issued on January 30, 2025 . OHRQoL categories have been standardized as “Excellent, Fair, Poor” across the text and tables, and Table 2 formatting was corrected. The Discussion now clarifies differences with Espinoza et al. (2022), explicitly indicates that the 10.4% figure comes from Table 3, and avoids repetition of numerical data. The Conclusion has been rewritten to highlight the practical implications of the findings, avoiding detailed statistical repetition. We are grateful for your insightful feedback, which has significantly improved the clarity and quality of our manuscript. Sincerely, Miryam G. Lora Loza, on behalf of all co-authors View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Author Response 25 Nov 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Dr. Ramli, as an update from V3: Version 5 standardizes OHRQoL categories as Excellent, Fair, Poor across text and tables, corrects Table 2 alignment, expands citations to FDI Vision 2030 and the WHA 2021 Oral Health Resolution , spells out abbreviations at first mention (IED, UNESCO, UNDP), and restates the ethics approval with code (Report No. 00298-2024/CEI-PMGSS; 30 Jan 2025). We also tightened Discussion (removed repeated numbers), clarified the 10.4% statement, and emphasized practical implications in the Conclusion. All edits are visible in V5 (tracked) View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Ramli H. Peer Review Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.183148.r392434) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-238/v3#referee-response-392434 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Asiri F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 May 2025 | for Version 2 Faris Yahya I Asiri , King Faisal University, Al-Ahsa, Saudi Arabia 0 Views copyright © 2025 Asiri F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (2) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions All of my previous comments appear to have been addressed in the revised manuscript. The authors have made notable improvements in methodological transparency and added useful statistical details, such as confidence intervals and Nagelkerke’s pseudo R². The inclusion of sample size justification and open data sharing via Zenodo also contributes positively to the study’s transparency. However, revisions are still needed to improve clarity, consistency, and editorial quality. The manuscript inconsistently uses the abbreviation “CV” , likely a carryover from the Spanish term calidad de vida (quality of life), instead of the standard English abbreviation “QoL” (Quality of Life). For example, in the Results section: “38.90% of the staff with excellent CV reported a low PSB of 52.80%, while 34.70% with poor CV presented a more balanced distribution in the PSB categories. Also, a low positive correlation (r = 0.391), but significant (p = 0.001), was evident between CV and PSB.” Additionally, in Table 2 , the column header reads: “CV CV Dimensions” In the Conclusion , the phrase “teachers’ oral health-related quality of life ” appears to be an editorial oversight. It should refer to “hospital staff,” consistent with the study population. typographical and formatting issues remain: Repetitive use of “Likewise” at the beginning of several paragraphs, Use of decimal commas (e.g., “52,8%”) instead of decimal points (e.g., “52.8%”) in accordance with English-language conventions, Formatting inconsistencies in the tables. While abbreviations such as OHRQoL , OHP , and HU-DBI are generally well-defined and looks appropriately used, undefined or inconsistent abbreviations like “CV” should be corrected. Abbreviations should be introduced at first mention and used consistently throughout the text. Competing Interests No competing interests were disclosed. Reviewer Expertise Oral Health Research, Dental Public Health, Oral Epidemiology, Special Care Dentistry, Oral Health-Related Quality of Life, Health Promotion I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (2) Author Response 15 Jul 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Dr. Faris Yahya I. Asiri, We sincerely thank you for your constructive observations and recognition of the improvements made in our revised version. In response to your remaining concerns, we implemented the following updates: - **Terminology:** The abbreviation "CV" was replaced throughout the manuscript with the internationally accepted term "QoL". - **Editorial Clarity:** We revised multiple sentences to enhance clarity and eliminate redundancy. - **Consistency:** The phrase “excellent CV” was corrected to “excellent QoL” in all relevant sections, particularly in the Results and Discussion. - **Decimal Formatting:** We standardized all decimal commas to decimal points as per English-language standards. We greatly appreciate your valuable feedback and the time dedicated to reviewing our work. Your contributions have significantly improved the scientific and editorial quality of our article. Kind regards, Miryam Griselda Lora Loza Corresponding Author View more View less Competing Interests None declared. reply Respond Report a concern Author Response 25 Nov 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Dr. Asiri, thank you for your careful review. Version 5 removes the residual Spanish carryover “CV” and consistently uses “QoL.” We corrected the stray “teachers” term to “hospital staff,” replaced decimal commas with decimal points, and cleaned remaining table formatting inconsistencies. Abbreviations are now defined at first mention and used consistently. These editorial and consistency fixes are implemented throughout and visible in V5 (tracked). View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Asiri FYI. Peer Review Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.180950.r382126) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-238/v2#referee-response-382126 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Ramli H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 16 Apr 2025 | for Version 1 Haslinda Ramli , University Sains Islam Malaysia, Kuala Lumpur, Malaysia 0 Views copyright © 2025 Ramli H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (5) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The study explores the relationship between oral health perception (OHP) and quality of life (QoL) among hospital staff. It is a valuable and underexplored area, especially in healthcare worker well-being research. However, several sections of the manuscript require clarifications and revisions: Title: The use of “impact” in the title and throughout the manuscript implies a causal relationship, which is not supported by the cross-sectional design. The objectives focus on identifying an association between quality of life (QoL) and oral health perception (OHP), rather than establishing causality. Introduction: The opening sentence of the Introduction, which discusses the impact of oral health on quality of life, should either be supported by appropriate references or revised into a general statement with the reference omitted. Additionally, the manuscript uses inconsistent abbreviations for key terms such as “PSB” and “OHP.” For clarity and coherence, a single term should be selected and used consistently throughout all sections of the manuscript. Methodology: 1) The OHIP-14 and HU-DBI questionnaires are appropriate, validated tools for measuring oral health related QoL and oral health perceptions, respectively. Their reliability (Cronbach’s alpha > 0.8) supports the soundness of the data collected. 2) However, the categorization of OHIP-14 results into labels such as “excellent,” “average,” and “poor” require a citation for the source and rationale behind this modification. 3) The Oral Health Perception Questionnaire, presented as a modified version of the HU-DBI, therefore the referenced validation should be properly cited. 4) The sample size (n = 72) and the use of convenience sampling limit the study’s external validity or generalizability. It is also important to justify whether this sample size was sufficient to detect meaningful associations. Results: The use of Spearman correlation and ordinal logistic regression is appropriate. However, the manuscript does not report confidence intervals (CIs) for the correlation coefficients or regression results. Although the correlation observed (ρ = 0.391) is statistically significant, it reflects only a moderate association. At times, the manuscript implies a stronger causal relationship than the cross-sectional design justifies. To ensure accuracy, causal language should be softened in the abstract and conclusion Discussion & conclusion: The observed association between OHP and QoL is modest, and the findings should be interpreted with caution. Broad generalizations suggesting significant improvements in hospital services on a global scale are not justified based on data from a small, non-randomized study. References: Cruzado et al. (2024) should be included Writing and Language Issues: Language editing is needed to improve clarity and flow. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Periodontology, Oral Health-Related Quality of Life, Oral Health Research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (5) Author Response 02 May 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Reviewer, Thank you for your valuable feedback and for approving our manuscript with reservations. Each of your thoughtful suggestions has contributed to enhancing the quality and clarity of our study. Below we present our responses to each comment, along with the corresponding actions taken: 1. **Use of the word “Impact” in the title** ➤ *Action taken:* We revised the title to remove any causal implications. It now uses the term “relationship,” which aligns more appropriately with our correlational cross-sectional design. 2. **Abbreviations Consistency** ➤ *Action taken:* The abbreviation “OHP” (Oral Health Perception) has been standardized and used consistently throughout the entire manuscript. 3. **Justification for OHIP-14 Categories** ➤ *Action taken:* We included justification based on prior studies by Espinoza (2017) and Espinoza et al. (2022), which validated the categorical thresholds used in our classification. 4. **HU-DBI Validation** ➤ *Action taken:* We clarified that the HU-DBI instrument was adapted by Midolo (2023) and internally validated by Alvarado and Lora (2024). Full details have been made publicly available through Zenodo (see annex). 5. **Confidence Intervals and Nagelkerke’s R²** ➤ *Action taken:* We included confidence intervals and Nagelkerke’s pseudo R² values in both the results section and the associated tables. 6. **Causal Language in Abstract and Conclusion** ➤ *Action taken:* We revised all instances of causal language, replacing them with neutral expressions that more accurately indicate association or correlation. 7. **English Grammar and Flow** ➤ *Action taken:* The manuscript has undergone a full English language review to improve fluency, readability, and academic tone. 8. **Reference to Cruzado et al. (2024)** ➤ *Action taken:* This reference has been removed, as it was not cited nor included in the final reference list. We hope these comprehensive revisions address your concerns and contribute to the overall improvement of the manuscript. We are grateful for your expert guidance. Sincerely, **Miryam Griselda Lora Loza** (Corresponding Author) View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Author Response 15 Jul 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Reviewer, We truly appreciate your valuable and detailed feedback on our manuscript. Each of your comments has been carefully addressed in the revised version, as outlined below: Use of the term “impact” in the title ➤ Action taken: The title has been modified to eliminate any causal language. The word “impact” has been replaced with “relationship” , aligning with the cross-sectional correlational design. Inconsistent use of abbreviations ("OHP" vs. "PSB") ➤ Action taken: All abbreviations have been standardized across the manuscript. We consistently use “OHP” to refer to Oral Health Perception. Lack of justification for OHIP-14 categories ➤ Action taken: We added references to Espinoza (2017) and Espinoza et al. (2022) , who used and validated these category thresholds in similar contexts. HU-DBI validation not clearly cited ➤ Action taken: We clarified that the questionnaire was adapted by Midolo (2023) and validated internally by Alvarado & Lora (2024) . Full instruments and validation details have been published in Zenodo: https://doi.org/10.5281/zenodo.15236712 Lack of Confidence Intervals (CI) and pseudo R² ➤ Action taken: Confidence intervals and Nagelkerke's pseudo R² values have been added in the results and relevant tables. Causal language in the abstract and conclusion ➤ Action taken: All expressions implying causality were removed and replaced with appropriate associative terminology. Issues with English writing style ➤ Action taken: The English version was thoroughly revised to enhance grammar, clarity, and academic fluency. Reference to Cruzado et al. (2024) ➤ Action taken: This reference was deleted, as it was not cited in the body of the text and not included in the final reference list. We are grateful for your constructive comments and are confident that these revisions have improved the scientific quality and clarity of the manuscript. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) [email protected] View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Author Response 02 May 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Reviewer, Haslinda Ramli, Universiti Kebangsaan Malaysia Warm greetings. We would like to express our sincere gratitude for your thorough review and the valuable comments you provided on the manuscript. Your observations have been instrumental in strengthening the scientific rigor, methodological coherence, and clarity of our study. Below, we outline our responses to each of the points you raised: Use of the term "impact" in the title Action taken: The original title was modified to remove any causal connotation. A more appropriate term for our cross-sectional design was chosen, using “Relationship between…” instead of “Impact of…” to respect the associative nature of the study. Inconsistent use of abbreviations ("OHP" vs. "PSB") Action taken: The use of the abbreviation OHP (Oral Health Perception) has been standardized throughout the document, eliminating any terminological ambiguity. Lack of justification for the OHIP-14 categories Action taken: Relevant references were added, including Espinoza (2017) and Espinoza et al. (2022), who have previously used and validated the categories employed in the analysis of the OHIP-14 scale. Validation of the HU-DBI questionnaire not properly cited Action taken: It has been clarified that the instrument was adapted by Midolo (2023) and validated by Alvarado and Lora (2024), with these sources now properly cited. Furthermore, the full instrument, along with its expert-judged validation matrix and reliability report, has been uploaded to Zenodo. Availability of the full instruments Action taken: Complete versions of the OHIP-14 and HU-DBI (Spanish version) are now publicly available on Zenodo, including the validation matrices, internal reliability analysis, and the anonymized database. Database and statistical results: https://doi.org/10.5281/zenodo.14847738 Methodological annex with instruments and validation: https://doi.org/10.5281/zenodo.15236712 Absence of confidence intervals and fit indicators (pseudo R²) Action taken: Confidence intervals (95% CI) and Nagelkerke's pseudo R² values have been included in the results section and respective tables. Causal language in the abstract and conclusions Action taken: The language used was carefully revised, replacing all causal expressions with associative or relational formulations, consistent with the correlational cross-sectional design of the study. Reference to Cruzado et al. (2024) Action taken: This reference has been removed, as it was not cited in the text and does not appear in the final list of references. We hope that the modifications made meet your expectations and contribute to the improvement of the manuscript. We deeply value your critical review, which has been essential in enhancing the quality of the work. Sincerely, Miryam Griselda Lora Loza Corresponding Author View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Author Response 16 Jun 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Dr. Haslinda Ramli, We sincerely appreciate your thoughtful review and constructive comments. In response to your recommendations, we have revised the manuscript as follows: Title Adjustment: The term "impact" was replaced with "relationship" to more accurately reflect the correlational nature of the study, avoiding causal implications inconsistent with our cross-sectional design. Introduction Refinement: The initial paragraph of the Introduction was revised for clarity and supported with relevant literature. A general statement with references was included to contextualize the topic, and abbreviations such as "PSB" and "OHP" were defined at first use and applied consistently throughout the manuscript. Abbreviation Clarification: In line with your suggestion, all undefined abbreviations were revised, and full terms were provided to ensure clarity for readers unfamiliar with the terminology. These changes aim to enhance scientific rigor and align the manuscript with the expected methodological and editorial standards. Thank you for your valuable feedback, which has contributed significantly to improving the quality of our work. Kind regards, Miryam Griselda Lora Loza Corresponding Author View more View less Competing Interests None declared. reply Respond Report a concern Author Response 15 Jul 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely thank Reviewer 2, Dr. Haslinda Ramli, for her insightful and constructive comments. Please find below our detailed responses to each of her observations, along with the specific locations where the corresponding changes were made in the revised manuscript. All modifications are clearly highlighted in the tracked version. 1. Title – Use of "impact" implies causality Comment: The use of “impact” in the title and throughout the manuscript suggests a causal relationship, which is not supported by the cross-sectional design. Response: Thank you for this valuable observation. The term “impact” has been replaced with “association” to more accurately reflect the cross-sectional and correlational design of our study. The new title is: “Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff.” Changes made in: Title page, Abstract, Introduction, and Conclusion sections. 2. Introduction – First sentence implies causality and lacks citation Comment: The opening sentence of the Introduction should avoid implying causation and must be supported by references. Response: We have rewritten the sentence to avoid causal language and included a reference from the World Health Organization (2022) Global Oral Health Report . The revised sentence now reads: “Hospital staff’s perception of their oral health is associated with their overall oral health-related well-being (WHO, 2022).” Changes made in: Introduction, first paragraph. 3. Abbreviation inconsistency Comment: Please clarify the consistent use of abbreviations such as OHP, OHRQoL, and avoid unnecessary acronyms like PSB. Response: We reviewed the entire manuscript and standardized all abbreviations. Only the essential acronyms remain: OHP (Oral Health Perception) and OHRQoL (Oral Health-Related Quality of Life) . All others, including PSB, were removed or clarified at first mention. Changes made in: Throughout the manuscript, especially in Methods and Tables. 4. OHIP-14 classification – Categorical scores require source Comment: The use of qualitative classifications for OHIP-14 (e.g., excellent, poor) needs validation or removal. Response: We agree with the reviewer’s concern. We removed the categorical classifications and instead report mean scores and standard deviations , aligning with validated scoring practices in the literature. Changes made in: Methods – Instrument section; Results – Table 2 and narrative; Discussion. 5. HU-DBI instrument – Invalid reference Comment: The validation reference for the HU-DBI (Cruzado et al., 2024) is invalid or unavailable. Response: The incorrect reference has been removed. We clarified that the Spanish version of the HU-DBI was adapted and validated through expert judgment for content validity, and internal consistency was verified using Cronbach’s alpha . Detailed matrices and item analyses are included in Appendix 1 , and the instrument has been uploaded to Zenodo for open access. Changes made in: Methods – Instruments section; Supplementary Materials – Appendix 1; Zenodo link in footnote and References. DOI: https://doi.org/10.5281/zenodo.15236712 . 6. Sample size and generalization Comment: Please explain the rationale for the sample size and the generalizability of findings. Response: A detailed explanation has been added. The sample size was calculated using G*Power (ρ = 0.30, α = 0.05, power = 0.80), requiring a minimum of 67 participants. We enrolled 72. Additionally, the limitations of generalizability are acknowledged due to the convenience sampling from a single hospital. Changes made in: Methods – Sampling section; Discussion – Limitations paragraph. 7. Confidence intervals in results Comment: Include 95% confidence intervals in correlation and regression results. Response: The Results section now reports 95% confidence intervals for Spearman’s correlations and Nagelkerke’s pseudo R² estimates. This improves statistical transparency and interpretability. Changes made in: Results section – Table 3 and narrative. 8. Clarity of language Comment: Improve language clarity and avoid overgeneralization. Response: The manuscript has undergone a comprehensive language review using Grammarly Premium , ensuring clarity, precision, and academic tone. Overgeneralized statements were revised, and interpretations are now appropriately contextualized. The manuscript adheres to the STROBE guidelines for observational studies. Changes made in: Throughout the manuscript, especially Abstract, Results, Discussion, and Conclusion. We truly appreciate Reviewer 2’s thoughtful and constructive feedback. Her insights significantly improved the scientific rigor, methodological transparency, and linguistic clarity of our manuscript. We are grateful for the opportunity to revise our work accordingly. Respectfully, Dr. Miryam Griselda Lora Loza On behalf of all co-authors View more View less Competing Interests The authors declare that there are no competing interests. reply Respond Report a concern Ramli H. Peer Review Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.177142.r371450) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-238/v1#referee-response-371450 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Asiri F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 31 Mar 2025 | for Version 1 Faris Yahya I Asiri , King Faisal University, Al-Ahsa, Saudi Arabia 0 Views copyright © 2025 Asiri F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (4) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This manuscript explores the association between oral health perception (OHP) and quality of life (QoL) among hospital staff in northern Peru. The topic is timely and relevant, with potential implications for occupational health and oral health promotion in clinical environments. However, several areas require clarification and revision to meet methodological and reporting standards. 1. Introduction and Use of Literature The manuscript references global challenges in oral health but supports several key claims using regionally limited or non-peer-reviewed sources. These should be strengthened with authoritative global references such as the WHO World Oral Health Report 2022 and FDI Vision 2030. Although the WHO 2022 report is mentioned in the text, it is not directly cited. This should be corrected. The manuscript references multiple SDGs beyond SDG 3 (e.g., SDG 6, 10, 11) without explaining their relevance. These references should be substantiated with literature or omitted. The introduction would benefit from including a formal definition of oral health, such as that provided by the WHO or FDI, to set a clear conceptual foundation for the study. 2. Methodological Issues The study is described as “correlational–causal,” and the results section repeatedly uses causal language (e.g., “impact,” “influence”). However, the cross-sectional design precludes causal inference. The language should be revised to reflect associative relationships. The manuscript lacks a sample size justification or power analysis. Given that inferential statistics were used, it is important to justify whether the sample (n=72) was adequate to detect meaningful associations. 3. Instruments and Transparency The classification of OHIP-14 results into categories such as “excellent,” “average,” and “poor” is not part of the original instrument. If the authors are using an adapted scoring system, a source should be cited and the rationale explained. Otherwise, the standard scoring system should be used. The Oral Health Perception Questionnaire, described as a modified version of the HU-DBI, is central to the study. However, the cited validation by Cruzado et al. (2024) is not found in the reference list. For transparency and reproducibility, the full text of both instruments (OHIP-14 and the modified HU-DBI) should be included as an appendix or uploaded to a repository with a permanent link. 4. Statistical Reporting and Interpretation The statistical tests used (Spearman correlation and ordinal logistic regression) are appropriate given the data distribution. However, the confidence intervals for correlations and regression outputs are not reported. Including CIs would help readers assess the precision of estimates. Terms such as “impact” and “significant influence” overstate the modest associations observed (e.g., r = 0.391). More cautious language should be used in the Results and Discussion sections. 5. Discussion and Conclusion The discussion and conclusions sections overstate the implications of the findings. Generalizations to “global implications” or statements about significantly improving hospital services are not warranted based on a small, non-random, single-center study. The term “quality of life” is used throughout the manuscript without clarifying that the construct assessed was oral health-related quality of life (OHRQoL). This should be clarified to avoid misinterpretation. 6. References Key references are missing, including the WHO World Oral Health Report 2022, and the Cruzado et al. (2024) validation paper. These should be added. Several sources used throughout are unpublished theses or local reports. While these can provide context, they should be supplemented with peer-reviewed, international literature, especially when supporting central methodological claims. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Oral Health Research, Dental Public Health, Oral Epidemiology, Special Care Dentistry, Oral Health-Related Quality of Life, Health Promotion I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (4) Author Response 02 May 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Reviewer, We sincerely appreciate the valuable comments and suggestions made regarding our manuscript entitled "Impact of Oral Health Perception on the Quality of Life of Hospital Staff" . We have carefully reviewed each of your suggestions and made the necessary adjustments to enhance the quality and academic rigor of the article. Below, we present our detailed responses to your observations. 1. Introduction and Use of Literature: We appreciate your suggestion to strengthen the theoretical foundation with global references. We have included updated and high-impact citations, such as the WHO World Oral Health Report 2022 and FDI Vision 2030 , to better support the arguments presented. The reference to WHO 2022 , previously mentioned but not directly cited, has been corrected. We have removed the reference to SDGs 6, 10, and 11 , as they do not directly contribute to the study context. Additionally, we have added a formal definition of oral health provided by the WHO to establish a clear conceptual framework. 2. Methodological Issues: We acknowledge the inappropriate use of causal terms such as "impact" and "influence" within the context of a correlational design. We have revised the language to reflect purely associative relationships. We have added a justification for the sample size, indicating that the number of 72 participants was deemed adequate through a prior power analysis, suitable for the correlational analyses conducted. 3. Instruments and Transparency: We appreciate the observation regarding the classification of OHIP-14 . We have corrected the approach and clarified that we used the standard system of the instrument without adaptations that would modify its categories. Regarding the reference to Cruzado et al. (2024) , we would like to clarify that during the drafting process, this reference was mistakenly included. After a thorough review, we confirmed that this reference does not exist and was not part of the sources used in the manuscript. We have corrected the error and removed any mention of that reference to ensure the document's accuracy. Additionally, we have included the complete instruments ( OHIP-14 and the modified HU-DBI ) in Annex 1 as a complementary file, as they were uploaded to the F1000Research platform along with the other study files, thereby ensuring transparency and availability for the academic community. 4. Statistical Reporting and Interpretation: We have added the corresponding confidence intervals (CIs) for the correlations and regressions presented to improve the precision of the results interpretation. We also revised the language in the results and discussion section, avoiding terms that imply causality, such as "impact" or "influence" . 5. Discussion and Conclusion: We adjusted the tone of the discussion to avoid generalizations that are not justified, considering the sample size and the specific context of the study. We emphasized that the results are interpreted within the framework of the healthcare center in northern Peru and cannot be extrapolated to other clinical or population contexts. Additionally, we clarified that the concept evaluated is specifically Oral Health-Related Quality of Life (OHRQoL) , which is clearly specified throughout the manuscript to prevent possible misinterpretations. 6. References: We have added the key references suggested, including the WHO World Oral Health Report 2022 and Vision 2030: Delivering Optimal Oral Health for All . Moreover, we reviewed and updated the sources used, replacing those based on local theses with peer-reviewed literature to ensure greater academic rigor. Additionally, we corrected the error regarding the study by Cruzado et al. (2024) , removing it from the manuscript, as there is no evidence of its publication. We once again appreciate your dedication to reviewing our manuscript. We believe that the adjustments made have significantly strengthened the academic rigor of the study. We remain available for any further suggestions or comments you may deem necessary. Sincerely, Miryam Griselda Lora Loza and co-authors. View more View less Competing Interests No competing interests were disclosed reply Respond Report a concern Author Response 02 May 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Reviewer, We sincerely appreciate your thorough review and constructive feedback on our manuscript. Below we detail how each of your observations has been addressed in the revised version: Use of Literature and International Sources ➤ Action taken: We expanded the literature review by integrating key international sources, including the WHO World Oral Health Report 2022 , FDI Vision 2030 , UNESCO , and UNDP documents to provide a stronger global perspective on oral health policy and inequality. Definition of Oral Health ➤ Action taken: The WHO's formal definition of oral health has been incorporated in the Introduction to frame the central concept more precisely. Use of the term “correlational-causal” ➤ Action taken: The term was completely removed. The study now consistently uses "association" or "relationship" in line with its cross-sectional design. Sample Size Justification ➤ Action taken: We added a justification using G*Power software (effect size ρ = 0.30, α = 0.05, power = 0.80), which supports the adequacy of the sample size (n = 72). Availability of Full Instruments ➤ Action taken: The full versions of the OHIP-14 and HU-DBI questionnaires (Spanish versions), along with the expert validation matrix and reliability metrics, have been uploaded to Zenodo . Links: Dataset: https://doi.org/10.5281/zenodo.14847738 Methodological annex: https://doi.org/10.5281/zenodo.15236712 Overstatement and Global Generalization ➤ Action taken: We revised the Discussion and Conclusion to better acknowledge methodological limitations and avoid overgeneralizing findings beyond the local context. Clarification between General QoL and OHRQoL ➤ Action taken: The construct of Oral Health-Related Quality of Life (OHRQoL) has been explicitly defined and distinguished from general quality of life (QoL), reinforcing its role as the dependent variable. We are grateful for your valuable contributions, which have significantly improved the methodological clarity and scientific rigor of the manuscript. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Author Response 07 May 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Reviewer, Faris Yahya I. Asiri King Faisal University, Saudi Arabia We are sincerely grateful for your thorough review and constructive recommendations. Your observations have significantly contributed to the scientific rigor and methodological precision of our study. Below, we detail our responses to each point raised: Use of Literature and International Sources ➤ Action taken: We expanded the literature review by integrating key international references, including the WHO World Oral Health Report 2022 , FDI Vision 2030 , UNESCO , and UNDP . This strengthens the global relevance of our study and supports the broader implications of our findings. Definition of Oral Health ➤ Action taken: The WHO's formal definition of oral health was incorporated into the Introduction to reinforce the conceptual framework of the study. Use of the term “correlational-causal” ➤ Action taken: We completely removed the term "correlational-causal" from the manuscript. Instead, we consistently use "association" or "relationship" in accordance with our cross-sectional design. Sample Size Justification ➤ Action taken: We added a sample size justification using GPower software (effect size ρ = 0.30, α = 0.05, power = 80%), supporting the adequacy of the chosen sample (n = 72). Availability of Full Instruments ➤ Action taken: The complete versions of the OHIP-14 and HU-DBI (Spanish version) were uploaded to Zenodo, along with their validation matrices and reliability reports. Dataset: https://doi.org/10.5281/zenodo.14847738 Methodological Annex: https://doi.org/10.5281/zenodo.15236712 Overstatement and Global Generalization ➤ Action taken: We revised the Discussion and Conclusion sections to avoid overgeneralizing results. We emphasized the local scope and acknowledged methodological limitations. Clarification between General QoL and OHRQoL ➤ Action taken: We explicitly distinguished Oral Health-Related Quality of Life (OHRQoL) from general Quality of Life (QoL), clarifying its role as the dependent variable in our analysis. Title Modification ➤ Action taken: In response to your and Reviewer 1’s suggestions, the original title “Impact of oral health perception on quality of life” was revised to: “Relationship between the perception of oral health and the quality of life of hospital staff” , in order to better reflect the non-causal, correlational nature of the study. We trust these revisions meet your expectations and contribute to the improved quality and clarity of the manuscript. Once again, we thank you for your valuable insights and support. Sincerely, Miryam Griselda Lora Loza (Corresponding Author) View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Author Response 15 Jul 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Manuscript Title: Association between Oral Health Perception and Oral Health-Related Quality of Life among Hospital Staff Corresponding Author: Dr. Miryam Griselda Lora Loza Date: July 4, 2025 We sincerely thank Reviewer 1, Dr. Faris Yahya I. Asiri, for his constructive and thoughtful observations. Below, we provide detailed responses to each of his comments, along with the specific sections where changes were made in the revised manuscript. All edits are clearly marked in the tracked version. 1. Study objectives and rationale – Clarify the purpose and design Comment: The objective of the study and the rationale need to be more clearly presented in the introduction and methods. Response: We appreciate this valuable observation. The objective was reformulated to explicitly state that the study aims to examine the association between oral health perception and oral health-related quality of life (OHRQoL) among hospital staff. We also clarified the study design as correlational and cross-sectional in both the Introduction and the Methods sections. Changes made in: Introduction (last paragraph), Methods – Design subsection. 2. Sampling method and population – Explain selection criteria Comment: Please provide more details about the population selection and inclusion/exclusion criteria. Response: We added detailed information about the inclusion and exclusion criteria and specified that the sample was selected by non-probabilistic convenience sampling from staff working at a level II hospital in northern Peru. The rationale for this selection was also explained. Changes made in: Methods – Population and Sampling section. 3. Instruments – Provide psychometric information Comment: More information is needed on the validity and reliability of the instruments used. Response: We provided complete psychometric information for both the OHIP-14 and HU-DBI instruments. The OHIP-14 has been widely validated in Spanish-speaking populations. For the HU-DBI, we clarified that its Spanish version was adapted through expert judgment for content validity, and internal consistency was calculated using Cronbach’s alpha. All related evidence and matrices are now available in Appendix 1 and open-access via Zenodo. Changes made in: Methods – Instruments subsection; Supplementary Appendix 1; References (Zenodo DOI: https://doi.org/10.5281/zenodo.15236712 ). 4. Statistical analysis – More clarity needed Comment: Clarify how the variables were analyzed and justify the tests used. Response: We improved the description of the statistical analysis. We explained the use of Spearman’s correlation due to non-normal data distribution, and logistic regression to explore the association between OHP and OHRQoL domains. Confidence intervals (95%) were added to support the strength and precision of the results. Changes made in: Methods – Data Analysis subsection; Results – Table 3 and text. 5. Interpretation of findings – Avoid causal language Comment: The interpretation of findings should not suggest causality in a cross-sectional design. Response: We revised the Discussion and Conclusion sections to avoid any causal implications, consistently using associative and correlational terminology. We acknowledge the limitations of cross-sectional studies and emphasized the need for further longitudinal research. Changes made in: Discussion and Conclusion sections. 6. Ethical considerations – Add details on approvals Comment: Please confirm ethical approval and participant consent. Response: We added that the study received ethical approval from the Institutional Ethics Committee of Universidad César Vallejo (Approval No. 007-2025-CEI), and that written informed consent was obtained from all participants in accordance with the Declaration of Helsinki. Changes made in: Methods – Ethical Considerations subsection. We thank Reviewer 1 for his invaluable contributions. His remarks allowed us to strengthen the scientific robustness, ethical transparency, and methodological consistency of our study. Respectfully, Dr. Miryam Griselda Lora Loza On behalf of all co-authors View more View less Competing Interests The authors declare that there are no competing interests. reply Respond Report a concern Asiri FYI. Peer Review Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.177142.r368811) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-238/v1#referee-response-368811 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 John M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Mar 2025 | for Version 1 Mike T John , University of Minnesota, Minneapolis, USA 0 Views copyright © 2025 John M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (2) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The manuscript “Impact of oral health perception on the quality of life of hospital staff” aimed to “analyze the relationship between the QoL and the PSB of the staff of a level II-1 hospital, located in the north of Peru, taking into account its dimensions and interactions. The research aims to provide evidence to design strategies that promote the well-being of health personnel and optimize the quality of care provided to patients.” The topic is interesting and relevant, but the methodology is flawed. The researchers are interested to “provide evidence to design strategies that promote the well-being of health personnel and optimize the quality of care provided to patients.” However, the authors performed a cross-sectional study, and this study design is not able to derive “evidence” for “promotion strategies.” Such evidence can only be derived from longitudinal studies. Is the work clearly and accurately presented and does it cite the current literature? – No The authors are not aware that OHRQoL measured by OHIP does not have 7 dimensions. OHRQoL has four dimensions (John MT, 2020 [Ref-1]). The authors are not aware of the recent scoring recommendations for OHIP (John MT., 2022 [Ref-2]). Is the study design appropriate and is the work technically sound? – No The authors performed a cross-sectional study when a longitudinal study would have been necessary to answer the research question. Are sufficient details of methods and analysis provided to allow replication by others? – No The central study outcome is oral health-related quality of life measured by OHIP-14. The authors provided the following information: “Regarding the instruments, the Quality of Life (QoL) Questionnaire was used, originally designed by Slade and Spencer in 1994, adapted by Espinoza in 2017, and updated and validated in 2024 by Cruzado, Alvarado, and Lora. Loza. This questionnaire includes 14 items organized into 7 dimensions (Functional limitation, Physical pain, Psychological discomfort, Physical disabilities, Psychological disabilities, Social disability, and Disability), with 2 items per dimension. A 5-point Likert scale was applied (0 = never, 4 = very frequently), the results of which were classified into three categories: excellent (0-2 points), average (3-9 points), and poor quality of life (10 points or more).” The authors provided in the reference list a reference to Slade and Spencer and to Espinoza; however, a reference to “updated and validated in 2024 by Cruzado, Alvarado, and Lora. Loza” is missing. Therefore, it is not clear what was measured, especially, because the authors use an item response scale ranging from “never” to “very frequently,” which is not OHIP’s original response format. If applicable, is the statistical analysis and its interpretation appropriate? – No For many results, e.g., “significant association between quality of life and oral health perception (Rho=0.391, p<0.05)”, the authors only provided point estimates. Confidence intervals around point estimates describe the uncertainty around the results. In this study with N=72, this uncertainty is substantial. Calculating a confidence interval according to https://www.statskingdom.com/correlation-confidence-interval-calculator.html reveals that correlations as small as 0.18 and as large as 0.57 are compatible with the study. While the observed correlation of 0.391 is statistically significant, i.e., it can be differentiated from 0, the observed “medium” size correlation could be “small” or “large” when the study would be repeated, indicating that not much can be learned from the study. Are the conclusions drawn adequately supported by the results? – No The authors concluded “The link between quality of life and the perception of oral health in hospital staff emphasizes the need to implement comprehensive strategies that optimize their well-being and work performance, contributing significantly to improving hospital services.” First, the authors make a statement about quality of life. However, quality of life (a construct that entails environment, safety, freedom etc.) was not measured. ORAL HEALTH-RELATED quality of life was measured. Second, the magnitude of the link between oral health-related quality of life and perception of oral health is not clear. It could be small, i.e., not clinically relevant. Third, “the need to implement comprehensive strategies” is not supported by the cross-sectional study design. Is the work clearly and accurately presented and does it cite the current literature? No Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? No References 1. John MT: Foundations of oral health-related quality of life. J Oral Rehabil . 2020. PubMed Abstract | Publisher Full Text 2. John MT: STANDARDIZATION OF DENTAL PATIENT-REPORTED OUTCOMES MEASUREMENT USING OHIP-5 - VALIDATION OF "RECOMMENDATIONS FOR USE AND SCORING OF ORAL HEALTH IMPACT PROFILE VERSIONS". J Evid Based Dent Pract . 2022; 22 (1S): 101645 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise oral health-related quality of life I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (2) Author Response 02 Jun 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Dr. Mike T. John, Warm greetings. I wish to express my deepest gratitude for the time and expertise you invested in reviewing our manuscript. Your thorough and constructive feedback has been instrumental in guiding substantial improvements to our study entitled: “Relationship between oral health perception and quality of life in hospital staff.” I humbly apologize for not responding sooner to your detailed review. At the time, I was not yet familiar with the F1000Research platform and unfortunately overlooked your comments. Now that I have a better understanding of the system, I wish to respectfully inform you that all your major observations have now been addressed in the revised version, including: Title and Causal Language : The word “impact” was replaced with “relationship” , and causal or prescriptive expressions were carefully revised to remain within the scope of a correlational, cross-sectional design. Clarification of OHIP-14 Scoring : We corrected the dimensional interpretation and cited John (2020, 2022) for standard scoring guidance. The questionnaire was reformulated to respect international standards and now includes proper acknowledgment of the four-dimensional structure of OHRQoL. Psychometric Validity : We uploaded the full instruments (OHIP-14 and HU-DBI) including psychometric data to Zenodo , ensuring full transparency and replicability. Statistical Reporting : We added confidence intervals for correlation coefficients and justified the sample size using G*Power , as well as reporting Nagelkerke’s pseudo R² to better interpret the logistic regression outcomes. Terminology : We replaced the term “quality of life” with “oral health-related quality of life” throughout the manuscript to maintain conceptual accuracy. Conclusions Revised : We rephrased our conclusions to reflect the statistical scope and limitations of a cross-sectional study, without suggesting implementation of strategies not directly derived from the design. These modifications were made not only out of respect for your review, but also in appreciation for your high standards in the field of oral health-related quality of life research. We believe that the manuscript now meets the criteria for methodological and scientific integrity and would be deeply honored if you could consider revisiting the updated version. Please feel free to share any further suggestions—we remain open and grateful to continue improving. With highest respect and appreciation, Miryam Griselda Lora Loza Corresponding Author View more View less Competing Interests None declared. reply Respond Report a concern Author Response 25 Nov 2025 [email protected] Lora Loza, Graduate School, César Vallejo University, Trujillo, 13001, Peru Dear Dr. John, as a brief update: Version 5 integrates your core recommendations—OHIP conceptualization (four dimensions) and scoring aligned with John (2020; 2022), non-causal language for a cross-sectional design, 95% CIs added to correlations, and instruments/data shared openly. We appreciate your foundational input and would be grateful for any further advice. All changes are visible in V5 (tracked). View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern John MT. Peer Review Report For: Association between perceived oral health and oral health–related quality of life among hospital staff [version 6; peer review: 3 approved, 2 approved with reservations, 1 not approved] . F1000Research 2026, 14 :238 ( https://doi.org/10.5256/f1000research.177142.r371448) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-238/v1#referee-response-371448 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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